Arterial Wall Research Articles

Peptide Receptor Radionuclide Therapy Using 90Y- and 177Lu-DOTATATE Modulating Atherosclerotic Plaque Inflammation: Longitudinal Monitoring by 68Ga-DOTATATE Positron Emissions Tomography/Computer Tomography.

Background: Atherosclerosis and its sequels, such as coronary artery disease and cerebrovascular stroke, still represent global health burdens. The pathogenesis of atherosclerosis consists of growing calcified plaques in the arterial wall and is accompanied by inflammatory processes, which are not entirely understood. This study aims to evaluate the effect of peptide receptor radionuclide therapy (PRRT) using 90Y- and 177Lu-DOTATATE on atherosclerotic plaque inflammation. Methods: Atherosclerotic plaques in 57 cancer patients receiving PRRT using 90Y- and 177Lu-DOTATATE were longitudinally monitored by 68Ga-DOTATATE PET/CT. The target-to-background ratio (TBR) and overall vessel uptake (OVU) were measured in eight distinct arterial regions (ascending aorta, aortic arch, descending aorta, abdominal aorta, both iliac arteries, and both carotid arteries) to monitor calcified plaques. Results: PET/CT analysis shows a positive correlation between calcified plaque scores and the 68Ga-DOTATATE overall vessel uptake (OVU) in cancer patients. After PRRT, an initially high OVU was observed to decrease in the therapy group compared to the control group. An excellent correlation could be shown for each target-to-background ratio (TBR) to the OVU, especially the ascending aorta. Conclusions: The ascending aorta could present a future reference for estimating generalized atherosclerotic inflammatory processes. PRRT might represent a therapeutic approach to modulating atherosclerotic plaques.

Effect of myogenic tone on agonist-mediated vasoconstriction in isolated arteries: A computational study

Background and objectiveVasoconstriction of the resistance artery is mainly determined by an integrated action of multiple local stimuli acting on the vascular smooth muscle cells, which include neuronal delivery of α-adrenoceptor agonists and intraluminal pressure. The contractile activity of the arterial wall has been extensively studied ex vivo using isolated arterial preparations and myography techniques. However, agonist-mediated vasoconstriction response is often confounded by local effects of other stimuli (e.g., pressure) and, it remained unclear whether the pressure-induced myogenic response has any implication on the efficacy of agonist-mediated vasoconstriction during blood flow regulation in tissues. A quantitative understanding of the influence of each stimulus is necessary to understand the interaction between multiple regulatory mechanisms, which is required to ensure timely oxygen delivery to meet tissue needs. MethodsWe developed a simple empirical model of isolated vessel vasoreactivity that includes passive vessel wall mechanics and a lumped representation of active smooth muscle activation as a function of agonist concentration and pressure. Pressure myograph data in dog renal arterioles and rat femoral arterioles, isovolumic myograph data in rat femoral arteries, and vasoactive data in rat skeletal muscle arterioles were analyzed using the model. The effect of physiological pressure changes on the sensitivities of vascular segments to adrenergic agonists phenylephrine and norepinephrine was evaluated. ResultsModel-based analysis of isolated vasoreactivity data, obtained due to changes in pressure and vasoconstricting agonists revealed that the strength of myogenic response of a resistance vessel has a strong influence on the sensitivity and dynamics of agonist response. An increase in intraluminal pressure was found to reduce the magnitude of agonist-mediated tone by lowering the sensitivity of the vessel segment to agonist. The passive mechanical properties of arterial wall considearably influence the agonist-mediated contraction in isolated arteries. These results demonstrate how passive vessel wall mechanics may dominate the vasoactive responses of the common myogenic and adrenergic pathways of smooth muscle contraction in blood flow regulation, supporting a long standing notion that there exists segment-specific vasoregulation in microvascular networks of various tissues. ConclusionThe present model provides a simple and powerful tool for quantifying ex vivo vasoreactivity of asolated arteries to qualitatively study the interaction between myogenic and α-adrenergic control of vascular tone in isolated vessels. Analysis of pressure myography data and isovolumic myography data in different sizes of vessels and tissues, in response to norepinephrine and phenylephrine revealed the importance of passive vessel mechanics in arteriolar vasomotion and setting up of basal vasomotor tone at single vessel-level. The present study will be useful to quantify the extent to which myogenic tone may influence agonist-mediated vasoconstriction and agonist effect on pressure-mediated myogenic response in microvascular networks during blood flow regulation in tissues.

Talin-1 variants associated with spontaneous coronary artery dissection (SCAD) highlight how even subtle changes in multi-functional scaffold proteins can manifest in disease.

Variants of talin-1 (TLN1) have recently been linked with spontaneous coronary artery dissection (SCAD) a condition where a tear can form in the wall of a heart artery necessitating immediate medical care. One talin-1 variant, A2013T, has an extensive familial pedigree of SCAD, which led to the screening for, and identification of, further talin-1 variants in SCAD patients. Here we evaluated these variants with commonly used pathogenicity prediction tools and found it challenging to reliably classify SCAD-associated variants, even A2013T where the evidence of a causal role is strong. Using biochemical and cell biological methods, we show that SCAD-associated variants in talin-1, which would typically be classified as non-pathogenic, still cause a measurable impact on protein structure and cell behaviour, including cell movement and wound healing capacity. Together, this indicates that even subtle variants in central mechanosensitive adapter proteins, can give rise to significant health impacts at the individual level, suggesting the need for a possible re-evaluation of the scoring criteria for pathogenicity prediction for talin variants.

CXCL12/CXCR4 pathway as a novel therapeutic target for RNF213-associated pulmonary arterial hypertension

Genetic backgrounds of patients with pulmonary arterial hypertension (PAH) were not fully investigated. A variant of c.14429G > A (p.Arg4810Lys) in the ring finger protein 213 gene (RNF213) was recently identified as a risk allele for poor treatment response and poor clinical prognosis in patients with PAH. However, the molecular mechanisms of the RNF213 p.Arg4810Lys variant in development of PAH are unknown. We investigated the underlying molecular mechanisms of RNF213-associated vasculopathy using an in vivo mouse model. RNF213+/p.Arg4828Lys mice, harboring the heterozygous RNF213 p.Arg4828Lys variant corresponding to the p.Arg4810Lys variant in humans, were created using the CRISPR-Cas9 system to recapitulate the genetic status of PAH patients. RNF213+/p.Arg4828Lys mice had a significant elevation of the right ventricular systolic pressure, hypertrophy of the right ventricle, and increased thickness of the pulmonary arterial medial wall compared with wild-type mice after 3 months of exposure to a hypoxic environment. C-X-C motif chemokine ligand 12 (CXCL12), a C-X-C chemokine receptor type 4 (CXCR4) ligand, was significantly elevated in the lungs of RNF213+/p.Arg4828Lys mice, and PAH was ameliorated by the administration of a CXCR4 antagonist. CXCL12-CXCR4 is an angiogenic chemokine axis, and immunohistochemistry demonstrated an increase in CXCR4 in vimentin-positive spindle-shaped cells in adventitia and interstitial lesions in RNF213+/p.Arg4828Lys mice and lung specimens from severe PAH patients with the RNF213 p.Arg4810Lys variant. We confirmed a cause-and-effect relationship between the RNF213 p.Arg4810Lys variant and PAH via the CXCL12-CXCR4 pathway. The findings in this study suggest that targeting this pathway might be a novel therapeutic strategy for RNF213-associated vasculopathy.

Optimizing Arterial Tissue Thickness Measurement Protocols: Digital Vernier Caliper Versus Digital Thickness Gauge.

The aim of this study is to analyze the reproducibility of sample thickness measurements taken by a non-experienced user by comparing a standard digital vernier caliper, with four different protocols, to a specialized thickness gauge. The current study is a methodological study where we examined the thickness of the porcine arterial wall in the thoracic aorta of six pigs. Two adjacent samples of 10 × 10 mm from each aorta were excised longitudinally from the anterior wall, resulting in twelve specimens. Five protocols were employed to measure the thickness of each sample. In four of these protocols, digital vernier calipers (Multicomp PRO MP012475) were utilized, while the fifth protocol utilized a specialized digital thickness gauge (Mitutoyo 547-500S, Mitutoyo Corp., Kawasaki, Japan). We observed a higher average thickness of the samples during the initial measurement compared to the second measurement (1.11 ± 0.16 vs. 0.94 ± 0.17, p = 0.0319) with the first protocol and smaller values than those determined at the last measurement (0.93 ± 0.15 vs. 1.10 ± 0.15, p = 0.0135) for the third protocol. Further, with the digital vernier calipers, we recorded lower values for all four protocols than for the digital thickness gauge determinations. In addition, we computed the ratio of the thicknesses measured during the first, second, and third measurements to analyze how consistent the values were across the three consecutive measurements, with no difference regarding the third, fourth, and control protocols. The digital thickness gauge offers dependable measurements, regardless of the user's expertise in assessing tissue thickness, and demonstrates a substantially higher reproducibility when compared to the digital vernier. We also found that taking an average of the thickness measurements from four specific points on each half of the sides or on each diagonal of each corner yielded consistently reliable results over time when using a standard digital vernier caliper instead of a specialized one.

Management of arterial hypertension in patients with peripheral arterial disease.

Hypertension is a major risk factor for peripheral arterial atherosclerotic disease (PAD). Hypertension deteriorates arterial wall function and the morphology of all layers of arteries. Endothelial cell injury enhances permeability and promotes migration of cholesterol and monocytes into the vessel wall. Increased blood pressure (BP) through hyperplasia of smooth muscle cells initiates remodeling of the arterial wall that increases peripheral resistance. Further, hypertension, particularly in patients with dyslipidemia, provokes atherosclerosis in different vascular territories, including the lower legs. Guidelines recommend treatment of hypertension in patients with PAD to reach the target BP of <130/80 mmHg. However, systolic BP (SBP) <120 mmHg may worsen oxygen delivery to the diseased leg and is related to a higher rate of cardiovascular (CV) events. Therefore, there is a J-shape relationship between SBP and the rate of primary outcomes. Any class of antihypertensive drugs, including beta-blockers, can be used for the treatment of hypertension in patients with PAD. Angiotensin converting enzyme (ACE) inhibitors may have some additional benefit over other antihypertensive drugs including improvement of perfusion of the diseased leg and are recommended even in patients with critical limb ischemia. In conclusion: hypertensive patients with PAD are at increased risk for CV events and treatment of raised BP is indicated, but SBP <120 mmHg and DBP <70 mmHg may contribute to adverse limb outcomes and other CV events. Consequently, PAD patients may require a different BP target than those without PAD.

Impact of aortic and pulmonary artery wall histology on radicular dilatation during the Ross procedure

ObjectiveIn our study, we aim to explore the structural differences between the aortic root and the pulmonary artery to better understand the process of pulmonary autograft dilatation during the Ross procedure.Materials and methodsWe studied twenty human fetuses (aged 14–36 weeks of gestation) and four adults (one female and three males, aged 30–45 years, mean age = 37 ± 16 years). Samples of aortic root and pulmonary artery were obtained through dissection. Histological examinations, including hematoxylin–eosin, Masson’s trichrome, and orcein staining, as well as immunohistochemical technique with caldesmon staining, were performed. Microscopic counting was conducted to assess the number of elastic laminae and smooth muscle cells in each arterial wall. Statistical analyses were performed using R software. Means and standard deviations were used to present central tendencies and data dispersion for elastic laminae and smooth muscle.ResultsSignificant histological differences were observed between the aortic root and pulmonary artery in both adults and fetuses. In fetuses, no difference was found between the two vessels in terms of elastic laminae (p = 0.26) and smooth muscle cells (p = 0.69). However, in adults, significant differences were found for elastic laminae (p < 0.001) and smooth muscle cells (p < 0.001) between the aorta and pulmonary artery.ConclusionsThe microscopic vascular structure impacts the mechanical properties of the pulmonary autograft wall and explains its observed dilatation remote from the Ross procedure due to wall stresses related to systemic pressure.

Ultrasound Strain Imaging for Characterizing Atherosclerotic Plaque in the Carotid Arteries of Asymptomatic Subjects

The rupture of vulnerable plaques in the carotid artery is a leading cause of strokes. While magnetic resonance imaging (MRI) is the standard for quantifying plaque composition, its high costs and lengthy procedure times limit large-scale use. Compound ultrasound strain imaging (CUSI) ultrasound offers a non-invasively alternative by assessing tissue deformation/strain within the arterial wall. Previous studies have demonstrated the relationship between strain values and plaque composition, primarily focusing on longitudinal acquisitions, which only image the proximal and distal parts of the wall. This study examines CUSI in transverse imaging planes, which enables visualization of the entire cross-section of the vessel wall. CUSI has already been validated on a symptomatic population. Therefore, the aim is to determine whether CUSI can differentiate plaque composition in asymptomatic individuals with an increased cardiovascular risk profile, validated by MRI. This cross-sectional study included 42 plaques in 28 participants. Ultrasound data were acquired with a Samsung Medison Accuvix V10 with an L5-13IS transducer and RF-interface. An experienced neuroradiologist classified plaques with MRI using the Siemens 3.0T MAGNETOM Skyra MRI (Erlangen, Germany) with a dedicated coil. Strain differences were compared across four plaque categories (calcified, lipid, hemorrhagic, fibrous/aspecific) and for vulnerable versus stable plaques. A difference in strain values was found between lipid and calcified plaques (Kruskal-Wallis test, p < 0.05). Additionally, vulnerable plaques exhibited higher strain values than stable plaques (independent samples test, p < 0.05). CUSI values differ between lipid and calcified and between stable and vulnerable plaques. Minor differences were found between the other plaque types.

Phosphate overload via the type III Na-dependent Pi transporter represses aortic wall elastic fiber formation.

Phosphate (Pi) induces differentiation of arterial smooth muscle cells to the osteoblastic phenotype by inducing the type III Na-dependent Pi transporter Pit-1/solute carrier family member 1. This induction can contribute to arterial calcification, but precisely how Pi stress acts on the vascular wall remains unclear. We investigated the role of extracellular Pi in inducing microstructural changes in the arterial wall. Aortae of Pit-1-overexpressing transgenic (TG) rats and their wild-type (WT) littermates were obtained at 8 weeks after birth. The thoracic descending aorta from WT and TG rats was used for the measurement of wall thickness and uniaxial tensile testing. Structural and ultrastructural analyses were performed using light microscopy and transmission electron microscopy. Gene expression of connective tissue components in the aorta was quantified by quantitative real-time polymerase chain reaction. Aortic wall thickness in TG rats was the same as that in WT rats. Uniaxial tensile testing showed that the circumferential breaking stress in TG rats was significantly lower than that in WT rats (p<0.05), although the longitudinal breaking stress, breaking strain, and elastic moduli in both directions in TG rats were unchanged. Transmission electron microscopy analysis of the aorta from TG rats showed damaged formation of elastic fibers in the aortic wall. Fibrillin-1 gene expression levels in the aorta were significantly lower in TG rats than in WT rats (p<0.05). Pi overload acting via the arterial wall Pit-1 transporter weakens circumferential strength by causing elastic fiber malformation, probably via decreased fibrillin-1 expression.

Blood flow through a stenosed left anterior descending coronary artery: Evaluation of loss coefficients in one-dimensional fluid–structure interaction model

Coronary arterial flow is affected by conditions such as atherosclerosis and stenosis resulting in coronary artery disease. Quantifying the flow fields across arteries is a key aspect in the functional assessment of occlusive arterial disease. An essential aspect of blood flow modeling is the mechanical interaction between the fluid flow and the arterial vessel wall. The present study focuses on the modeling of blood flow within the left anterior descending artery affected with stenosis. A one-dimensional (1D) model was developed to study the transient blood flow characteristics in the artery. The 1D model is coupled with the material tube law to account for the flexibility of the arterial wall. The loss coefficients that account for the local viscous and turbulent losses across the stenosis region are estimated accurately in terms of the varying local cross-sectional area, instead of empirical constants used in the literature. It was observed that the magnitude of viscous losses decreases with an increase in the severity of stenosis. For lower degree of stenosis (&amp;lt;30%), the local turbulent losses are insignificant compared to the viscous losses. The maximum deformation of the vessel wall is ∼0.12mm at t=0.45s for s=70%. During the cardiac cycle (T=0.9s), the artery is observed to be experiencing dilation (Δr&amp;gt;0) in the upstream region, whereas contraction (Δr&amp;lt;0) in the downstream region for all the values of severity (s). A fractional flow reserve of 58.53% was noticed in a stenosed artery of 70% severity.

Application of Computational Fluid Dynamic Simulation of Parent Blood Flow in the Embolization of Unruptured A1 Aneurysms

To investigate the effect of microcatheter shaping based on the parent artery mainstream line of blood flow simulated using the computational fluid dynamics (CFD) technique on embolization of unruptured aneurysms on the posterior wall of the anterior cerebral artery (ACA) A1 segment. Patients with unruptured cerebral aneurysms on the posterior wall of the ACA A1 segment were retrospectively enrolled and treated with endovascular embolization after microcatheter shaping. The clinical, embolization and follow-up data were analyzed. Eight patients were enrolled and treated with endovascular embolization. Eight microcatheters were steam shaped in vitro and were all successfully navigated to the right location in the in vitro experiment. During the embolization procedure, seven microcatheters were successfully navigated to the right location for embolization. In the remaining one patient who had tortuous cerebral arteries, reshaping of the microcatheter based on the parent artery mainstream of blood flow made successful navigation of the microcatheter to the right place. Complete occlusion was obtained in seven (87.5%) aneurysms and residual aneurysm neck in the remaining one (12.5%). At angiographic follow-up in 6 (75%) patients, the Raymond grade was I in 5 (83.3%) and II in the rest one (16.7%). Use of CFD simulation of parent artery blood flow for microcatheter shaping in the embolization of unruptured aneurysms on the posterior wall of the ACA A1 segment is safe and effective in navigating the microcatheter to the right location for embolization, resulting in good stability and support for the embolization.

LncRNA MEG3 aggravates acute pulmonary embolism-induced pulmonary arterial hypertension by regulating miR-34a-3p/DUSP1 axis.

Acute pulmonary embolism (APE)-induced pulmonary artery hypertension (PAH) is a fatal disease. The miR-34-3p/DUSP1 has inhibitory effects on the thickening of the pulmonary arterial walls in APE rats and the proliferation of platelet-derived growth factor-BB (PDGF-BB)-induced human pulmonary arterial smooth muscle cells (hPASMCs). Herein, the lncRNAs regulating the miR-34a-3p/DUSP1 axis in APE and PAH are further explored in vitro and in vivo. MEG3 targeted miR-34a-3p. MEG3 overexpression potentiated the effects of PDGF-BB treatment on promoting the viability and proliferation of hPASMCs, as well as the mPAP level in APE rats. Also, overexpressed MEG3 strengthened PDGF-BB-induced upregulation of MEG3, NOR-1, PCNA and DUSP1, as well as downregulation of miR-34a-3p in hPASMCs and APE rats. However, shMEG3 generated opposite effects. MiR-34a-3p mimic reversed the effect of MEG3 overexpression, and DUSP1 overexpression neutralized the effect of MEG3 downregulation on PDGF-BB-induced hPASMCs and APE rats.MEG3 aggravates APE-induced PAH by regulating miR-34a-3p/DUSP1 axis, holding a great promise as a novel biomarker for PAH treatment.

РАСПРЕДЕЛЕНИЕ ПОЛИМОРФНЫХ ВАРИАНТОВ ГЕНОВ ТРАНСФОРМИРУЮЩЕГО ФАКТОРА РОСТА Β1, Α1 ЦЕПИ КОЛЛАГЕНА IV ТИПА И ЭНДОТЕЛИНА-1 У ПАЦИЕНТОВ С АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИЕЙ

Background. Аn important role in the development and progression of arterial hypertension (AH) is played by the influence of polymorphic variants of genes. The polymorphisms C(-509)T, T869C and G915C of the transforming growth factor β1 (TGFB1) gene, A110186299G and C110196387T of the collagen type IV α1 chain (COL4A1) gene, G5665T of the endothelin-1 (EDN1) gene can contribute to the remodeling of the arterial wall. Objective: To assess the distribution of the polymorphic variants C(-509)T, T869C and G915C of the TGFB1 gene, A110186299G and C110196387T of the COL4A1 gene, G5665T of the EDN1 gene in male patients of 30-49 years old with hypertension living in the Grodno region. Material and methods: The study included 204 men (65 healthy individuals and 139 patients with grade 1 and 2 hypertension). Survey data (general clinical examinations, genotyping by polymerase chain reaction) were analyzed using the STATISTICA 10.0 program. Results. In patients with AH and in healthy men the frequency of occurrence of the T allele of the G5665T polymorphism was 16.8% and 13.9% (р=0.45), that of the T allele of the C(-509)T polymorphism – 34.2% and 36.9% (р=0.66) respectively. The frequency of the T allele of the T869C polymorphism was 41.4% and 40.8% (p=0.99), and that of the C allele of the G915C polymorphism – 7.9% and 6.9% (р=0.84) correspondingly. The frequency of the A allele of the polymorphism A110186299G comprised 35.6% and 37.7% (р=0.74), that of the T allele of the polymorphism C110196387T – 46.4% and 43.8% (р=0.63) respectively. Conclusions. The frequency of occurrence of genotypes and alleles of the studied polymorphisms is comparable among male patients with grade 1-2 AH and practically healthy individuals.

Anti-inflammatory Activity of Clitoria ternatea L. and Hibiscus sabdariffa L. Extract Combination in Reducing VCAM-1 Levels in Atherosclerosis

Atherosclerosis occurs when plaque accumulates and hardens within the arterial walls, leading to blood vessel blockages and increasing the risk of coronary heart disease (CHD). The extracts of butterfly pea (Clitoria ternatea L.) and roselle (Hibiscus sabdariffa L.) contain flavonoids that possess strong antioxidant and anti-inflammatory properties. This study aims to assess the effects of the combined extract of butterfly pea and roselle (EKTR) on atherosclerosis biomarkers such as Vascular Cell Adhesion Molecules-1 (VCAM-1), Intercellular Adhesion Molecule-1 (ICAM-1), and Interleukin-6 (IL-6). The research employed a True Experimental Laboratory approach using a Post-Test Control Group Design. The subjects were 36 female Wistar rats (Rattus norvegicus L.), randomly divided into six groups through a Completely Randomized Design (CRD). Data were collected on the levels of VCAM-1, ICAM-1, and IL-6 in the serum of obese white rats, measured using an ELISA photometer. Data analysis was conducted using SPSS version 18, with statistical evaluation performed via one-way ANOVA and Tukey's post hoc test. The results showed that increasing doses of EKTR led to significant reductions in atherosclerosis biomarkers such as VCAM-1, ICAM-1, and IL-6 compared to the positive control and other groups. At a dose of 500 mg/kg BW, group F3 recorded IL-6 levels of 30.49 ± 1.60 ng/mL, VCAM-1 level of 29.42 ± 2.58 ng/mL, and ICAM-1 levels of 28.42 ± 1.72 ng/mL. In conclusion, butterfly pea and roselle, rich in flavonoids with potent antioxidant and anti-inflammatory properties, are effective as traditional remedies for reducing atherosclerosis biomarkers and for preventing and treating coronary heart disease (CHD) at an optimal dose of 500 mg/kg BW.

Effect of Oral Administration of Collagen Peptide OG-5 on Advanced Atherosclerosis Development in ApoE-/- Mice.

Atherosclerosis is a chronic inflammatory disease of the arterial wall, which involves multiple cell types. Peptide OG-5 is identified from collagen hydrolysates derived from Salmo salar and exhibits an inhibitory effect on early atherosclerosis. The primary objective of this study was to investigate the impact of OG-5 on advanced atherosclerotic lesions as well as its stability during absorption. In this study, the ApoE-/- mice were employed to establish advanced atherosclerosis model to investigate the treatment effect of peptide OG-5. The results showed that oral administration of OG-5 at a dosage of 150 mg/kg bw resulted in a 30% reduction in the aortic plaque formation area in ApoE-/- mice with few bleeding risks. Specifically, intervention with a low dose of OG-5 (50 mg/kg bw), initiated in the early stage of atherosclerosis, continues to provide benefits into the middle and late stages without bleeding risks. Furthermore, treatment of OG-5 increased expression levels of contractile phenotype markers and reduced the accumulation of lipoprotein in VSMCs induced by ox-LDL. Peptide OG-5 could ensure transport across Caco-2 cell monolayers, exhibiting a Papp value of 1.80 × 10-5 cm/s, and exhibited a robust stability in plasma with remaining content >70% after 8 h incubation. In vivo studies revealed that OG-5 reached maximum concentration in blood after 120 min. The present results demonstrate the potential efficacy of peptide OG-5 as a promising agent for intervention in anti-atherogenesis strategies.

Successful management of mycotic anastomotic pseudoaneurysm of interposition vein graft following a carotid endarterectomy: a case report

BackgroundAnastomotic pseudoaneurysms of interposition vein grafts are a rare entity that requires urgent management to prevent life-threatening complications, such as rupture and thromboembolism, especially when involving the carotid arteries. As these are rare complications and literature is sparse, we believe that this case report can aid the decision-making process in similar circumstances.Case presentationA 49-year-old Ukrainian male patient presented with a false aneurysm of both distal and proximal anastomosis of an interposition vein graft between the common carotid artery and the internal carotid artery, which was previously performed as a bailout procedure after the patient developed a complication of carotid surgery. The patient was successfully treated with extra-anatomical interposition of a vein graft from the subclavian artery to the remnant of extracranial internal carotid artery and en bloc excision of the previous vein graft with the false aneurysms.ConclusionMycotic anastomotic pseudoaneurysms following carotid endarterectomy represent a rare yet serious complication in vascular surgery that requires urgent treatment. While endovascular techniques could represent an alternative option, open surgical repair is still the standard of care for this pathology, offering advantages in preventing postoperative ischemic complications and ensuring optimal long-term outcomes. The open approach provides direct visualization of the pseudoaneurysm. It allows the meticulous debridement of the infected tissues and an accurate reconstruction of the arterial wall with autologous or synthetic grafts. In light of the substantial evidence supporting its superiority, open surgical repair should remain the preferred approach in addressing mycotic anastomotic pseudoaneurysms following carotid endarterectomy. Future research should continue to explore advancements in other surgical techniques and refine treatment strategies to enhance patient outcomes in this challenging clinical scenario.

Preparation and evaluation of soft gelatin capsules loaded with astaxanthin, niacin and garlic oil for removal of plague in atherosclerosis

Atherosclerosis, a chronic inflammatory disease, is the leading cause of cardiovascular diseases. In atherosclerosis, the arterial walls are characterized by plaque deposits on the inside of arteries. This study focuses on preparing a fill formulation to remove plaque in atherosclerosis, then analyse the pharmaceutical ingredients used and later produce soft gelatin capsules. Soft gelatin capsules are hermetically sealed, one-piece capsule which has a suspension or semi-solid as fill. Oxidative stress and inflammation are factors responsible for the development of atherosclerosis. Hence, the active pharmaceutical ingredients (APIs) chosen for fill formulation need to possess effective anti-oxidant and anti-inflammatory properties. A novel combination of APIs: Astaxanthin, Niacin and Garlic oil were chosen for the removal of plaque in atherosclerosis. Each of these APIs is known to possess a specific function in the control of plaque development. The fill formulation prepared was analysed for its recovery using various analytical techniques like UV spectrophotometry, high-performance liquid chromatography (HPLC) and thin-layer chromatography (TLC). This fill formulation was encapsulated within the gelatin shell prepared to produce soft gelatin capsules. The encapsulated soft gelatin capsules were evaluated based on various parameters which include average net weight, disintegration test, loss on drying and dissolution.

Elastographic Assessment of Atherosclerotic Plaques and Determination of Vascular Risk in Patients with Rheumatoid Arthritis.

Objectives: The present study aimed to examine the role of two-dimensional shear wave elastography (SWE) in the assessment of the vascular wall of the carotid arteries and atherosclerotic plaques in patients with rheumatoid arthritis with moderate and low disease activity versus healthy controls. Methods: An observational case-control study was carried out at the University Medical Hospital "Kaspela" in Plovdiv, Bulgaria, from June 2023 to August 2024. This study included 24 patients with rheumatoid arthritis (RA) and 25 healthy controls. We employed two-dimensional SWE (2D-SWE) to examine the vessels around the plaques. The potential links with the degree of stenosis, plaque type, and cardiovascular risk were analyzed. Results: In the RA group, the 2D-SWE values showed significant positive correlations with the severity of the atherosclerotic plaques (rs = 0.461; 95% CI: 0.049 to 0.739; p = 0.023) and the degree of stenosis (rs = 0.920; 95% CI: 0.793 to 0.970; p < 0.001). Based on 2D-SWE, a ROC curve analysis distinguished higher severity plaques from lower severity plaques with an AUC = 0.818, 95% CI: 0.683 to 0.913. The optimal cut-off value of 2D-SWE > 32.40 kPa was associated with a sensitivity of 96%, a specificity of 56%, a positive predictive value (PPV) of 66.70%, and a negative predictive value (NPV) of 92.90%. Conclusion: Elastography can be an effective technique for assessing and stratifying atherosclerotic plaques in patients with RA, as well as for aiding in the early detection and subsequent prevention of future complications.

Influence of Forced Field on Blood Flow in an Overlapping Stenosed Arterial Section

This article presents the theoretical analysis of the nonlinear behavior of the blood flow through an angled arterial segment with overlapping stenosis. A mathematically created time-variant stenosis emerges from the formation of arterial narrowing brought on by atheroma. An elastic cylindrical tube with a moving wall is used to represent the artery, and the Casson liquid is used to simulate blood that flows through it. The nonlinear elements that arise in the equations, govern blood flow are taken into account. The impact of the pulsatile pressure gradient that caused by the regular heartbeat on the flow process in the stenosed artery is demonstrated mathematically. By employing the boundary conditions, the present analytical technique can easily compute the velocity profiles, wall shear stress, and flow resistivity. To carry out a systematic quantitative study, the desired quantities are numerically computed. The results are graphically presented in the discussion section. They provide an overview of how the degree of stenosis and the malleability of the artery wall influence blood flow abnormalities. The application of the current model is adequately justified by many significant conclusions.

Intravascular Ultrasound Assessment of Distal Trans-Radial Access in Patients Undergoing Percutaneous Coronary Intervention.

Distal trans-radial access (dTRA) for percutaneous coronary interventions (PCI) is increasingly gaining attention due to its potential to mitigate radial artery occlusion (RAO). However, a comprehensive understanding of the mechanical impact of the devices on the radial artery (RA) wall remains limited. Using a complete intravascular ultrasound (IVUS) evaluation of the RA, including also the vascular access site, we aimed to evaluate all the consequences related to the catheterization on the RA wall, starting from the vascular access, comparing conventional sheath and sheathless approaches. This is an observational, prospective, multicenter study aimed to assess the entire RA wall immediately after IVUS-guided PCI via-dTRA. IVUS assessment included quantitative measurements (minimal lumen area [MLA], minimal vessel area [MVA]) and qualitative observations (dissections, vasospasm). Study objectives included delineating RA wall structure post-PCI and comparing findings between conventional and sheathless approaches. Fifty patients (21 [42%] with conventional sheath, 29 [58%] sheathless) were enrolled between March 2023 and February 2024. Female patients were more prevalent in the convention sheath group (38% vs. 7%, p < 0.001). Sheathless approach utilized 7-French guiding catheters more frequently (33% vs. 86%, p < 0.001). Post-procedural IVUS identified dissections in 12% of cases, with no significant difference between approaches. Arterial vasospasm was present in a quarter of patients, numerically higher in the conventional sheath group (29% vs. 21%, p = 0.5). MLA and MVA were comparable between groups, though MLA and MVA were lowest at the proximal segment of the RA only in the conventional sheath group (p < 0.001). No RAO was documented during the IVUS evaluation. The intravascular assessment of dTRA after coronary interventions, utilizing either conventional or sheathless approaches, including large-bore guiding catheters, demonstrated a relatively low incidence of access-related complications such as dissection and vasospasm, without affecting the flow and patency of the proximal RA.