Purpose: Our study investigated the risk of recanalization, from a hemodynamic perspective in six patients with visceral aneurysm embolization using coil packing, occasionally along with combined outflow vessel embolization. Methods: Blood flow simulations were performed using anatomically realistic vessel geometry created from the patient’s computed tomography images. A porous media model that represented flow in the embolized aneurysmal region was employed. Stagnant volume ratio (SVR) was evaluated to quantify the stagnation of flow within the embolized aneurysm. Results: SVR was elevated, with increased packing density (PD), in all patients. In the patient with recanalization, the rate of increase in SVR for PD <20% was smaller than that in the other five other patients, and the SVR for the actual PD was the lowest. In the five patients without recanalization, the SVR for the actual PD was greater than 80% at Reynolds number of 300. Conclusion: Individualized blood flow simulations focusing on SVR would be a useful tool to determine the clinical endpoint, the optimum individualized PD and to optimize postoperative follow-up of visceral aneurysms.
frequently observed in patients with implantable cardioverter defibrillators (ICD).Conversely AT/AF incidence in the single chamber ICD patients has been reported to be between 2 and 5%, possibly due to monitoring limits and to the fact that AT/AF are frequently asymptomatic.Purpose: To evaluate real AT/AF incidence in patients with no history of AT/AF, no anti-arrhythmic drug (AAD) therapy and wearing a new-generation single chamber ICD with specific AT/AF diagnostics.Methods: Consecutive single-chamber ICD patients were prospectively followed by 23 Italian cardiologic centers in an observational research.Clinical and device data were collected and reviewed by expert cardiologists to assess AT/AF occurrence through in clinic visit and/or remote transmissions of device data.Results: 94 (83.1% male, 60 years old, 55% with a CHA2DS2-VASc≥2) were followed for a median observation period of 389 days.AT/AF episodes occurred in 22 (23.4%)patients when considering at least 5 minutes duration, in 16 (17%) for AT/AF ≥1 hours, in 10 (10.6%) for AT/AF ≥6 hours, in 4 (4%) for AT/AF ≥1 day.Conclusions: Our multicenter real-world experience in a population of single chamber ICD patients with no history of AT/AF shows that a relevant percentage of patients develops new onset AT/AF in 1 year follow-up.Compared with literature data, the use of a specific AF diagnostics allowed cardiologists to improve the knowledge about patients with AT/AF and at risk of stroke and to optimize AT/AF management in terms of oral anticoagulation, and rate-control or rhythm control strategies.
Stroke is the third leading cause of death in the United States. The degree of luminal narrowing evaluated by angiography is the standard for assessing the risk of stroke in patients with carotid atherosclerosis and for determining the need for surgical intervention. However, multiple studies have shown that clinical events arise not from the degree of stenosis but from the morphologic characteristics and plaque composition. This is borne out by the difference in absolute risk reduction between symptomatic and asymptomatic patients who receive surgical carotid endarterectomy (CEA). Future clinical practice may diagnose patients with high-risk atherosclerosis, based on plaque characteristics and morphology rather than the degree of stenosis alone. Carotid MRI is a noninvasive imaging method that can provide information on atherosclerotic plaque morphology, composition, and progression or regression. This chapter describes the current capabilities of MRI for visualizing carotid atherosclerosis, including MRI protocols to appropriately evaluate carotid plaque, the image features of carotid arteries, and the future direction of carotid MR imaging and how it can be better used for the management of patients with subclinical atherosclerosis, resulting in a higher quality of life.
Angioplasty for cases of chronic total occlusion of renal artery with/without atrophic kidney is generally not recommended. We herein report a 57-year-old man who presented with renin-mediated refractory hypertension caused by occlusion of a unilateral renal artery leading to kidney atrophy (length: 69 mm). Angioplasty favorably achieved blood pressure control with normalized renin secretion and enlargement of the atrophic kidney to 85 mm. Timely angioplasty can be beneficial in select patients, even with an atrophic kidney and total occlusion, especially in cases with deterioration of hypertension within six months and the presence of collateral perfusion to the affected kidney.
Men have a greater prevalence of high-risk carotid plaque features associated with stroke compared with women who have ≥50% stenosis, but little is known about these features in less significantly stenotic carotid arteries. This study aims to evaluate sex differences in complicated carotid plaque features in asymptomatic patients with <50% stenosis.
MATERIALS AND METHODS:
Ninety-six patients (50 men, 46 women) with <50% carotid stenosis on MRA who had been referred for analysis of contralateral >50% carotid stenosis were included. The associations between sex and plaque features as identified by 3T MR carotid plaque imaging were examined by using logistic and linear regression models controlling for demographic characteristics, MRA stenosis, and the presence of contralateral plaque features.
RESULTS:
The presence of a thin/ruptured fibrous cap (16% versus 2%, adjusted odds ratio = 8.57, P = .047), IPH (24% versus 6%, adjusted odds ratio = 4.53, P = .027), and American Heart Association type VI plaque (26% versus 6%, adjusted odds ratio = 5.04, P = .017) was significantly higher in men than in women. These associations remained significant following adjustment for contralateral plaque features. Men demonstrated a larger percentage volume of LR/NC (median, 1.66% versus −0.21%; P < .01). Calcification was not significantly associated with sex.
CONCLUSIONS:
There is a sex difference of higher risk carotid plaque features during the early stage of disease seen in patients recruited for MR imaging evaluation of contralateral moderate-to-severe stenosis. Given the potential of using LR/NC without or with IPH to monitor therapy, these results indicate the possible importance of sex-based management in patients with asymptomatic carotid atherosclerosis across all stages of carotid stenosis.
Abstract Background Magnetic resonance arterial spin labeling (ASL) imaging with multiple post-labeling delays (PLDs) provides the bolus arrival time (BAT) as well as cerebral blood flow (CBF) to characterize the cerebral hemodynamics. However, the complexity of data acquisition and processing inhibits the calculation of BAT. We developed a simple method for approximating BAT using single-PLD ASL imaging and single-photon emission computed tomography (SPECT). We conducted a proof-of-concept study in patients with carotid artery stenosis. Methods We introduced the ASL/SPECT ratio, calculated by dividing the tissue magnetization in pulsed continuous ASL by the CBF measured using SPECT. In theory, the ASL/SPECT ratio has a positive relationship with BAT. Our proof-of-concept study included 63 patients who underwent carotid endarterectomy (CEA) in our hospital from 2014 to 2019. After preprocessing the ASL and SPECT datasets using three-dimensional stereotactic surface projection, we calculated the ASL/SPECT ratio at each voxel. We investigated the correlation between the preoperative BAT and the postoperative CBF. Results We found a positive correlation between the delay of BAT and the increase rate of CBF in the ipsilateral middle cerebral artery territory (Pearson’s correlation coefficient, 0.444; 95% confidence interval, 0.220–0.623; p=0.000269). Four patients (6.3%) presented with hyper-perfusion phenomenon. Visualization of the BAT revealed that the area prone to postoperative hyper-perfusion presented with a delayed preoperative BAT. Conclusions Our findings suggest the feasibility of the BAT approximated using ASL and SPECT in patients with chronic steno-occlusive cerebrovascular diseases. The proposed concept is also applicable to ASL and any modalities that measure CBF.
blood pressure despite similar rates of prescription and doses of beta-blockers and RAAS inhibitors.After multivariate analysis, only the AHA risk score (OR (95% CI): 1.07 (1.04-1.10),p<0.001) and LVEF (OR (95% CI): 0.95 (0.92-0.98), p=0.002) were significantly and independently associated with the lowest tertile of retinal vascular density measured by OCT angiography.The strong association between the AHA risk score and vascular density was confirmed by a significant Pearson correlation coefficient, (R= -0.48, p<0.001). Conclusion:Retinal inner vascular density found with OCT angiography was strongly associated with cardiovascular risk and with impaired LVEF in patients admitted for ACS.These preliminary results could help to target a specific population at high risk for cardiovascular events.
Over the past decade, a large body of evidence has emerged demonstrating an integration of metabolic and immune response pathways. It is now clear that obesity and associated disorders such as insulin resistance and type 2 diabetes are associated with a metabolically driven, low-grade, chronic inflammatory state, referred to as “metaflammation.” Several inflammatory cytokines as well as lipids and metabolic stress pathways can activate metaflammation, which targets metabolically critical organs and tissues including adipocytes and macrophages to adversely affect systemic homeostasis. On the other hand, inside the cell, fatty acid-binding proteins (FABPs), a family of lipid chaperones, as well as endoplasmic reticulum (ER) stress, and reactive oxygen species derived from mitochondria play significant roles in promotion of metabolically triggered inflammation. Here, we discuss the molecular and cellular basis of the roles of FABPs, especially FABP4 and FABP5, in metaflammation and related diseases including obesity, diabetes, and atherosclerosis.
