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Tortuosity of the Internal Carotid Artery and Its Clinical Significance in the Development of Aneurysms. J Clin Med 2019; 8:jcm8020237. [PMID: 30759737 PMCID: PMC6406528 DOI: 10.3390/jcm8020237] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 01/16/2019] [Accepted: 02/01/2019] [Indexed: 02/03/2023] Open
Abstract
Tortuosity of blood vessels is a common angiographic finding that may indicate systemic disease and can be correlated with vascular pathologies. In this work, we determined whether patients with and without internal carotid artery (ICA) aneurysm presented with differences in its tortuosity descriptors. We retrospectively analysed data of 298 patients hospitalized between January 2014 and June 2018. For each patient's imaging data, we extracted a curve representing the ICA course and measured its Relative Length (RL), Sum of Angle Metrics (SOAM), Product of Angle Distance (PAD), Triangular Index (TI), and Inflection Count Metrics (ICM). We found that patients with an ICA aneurysm had significantly lower RL (0.46 ± 0.19 vs. 0.51 ± 0.17; p = 0.023) and significantly higher SOAM (0.39 ± 0.21 vs. 0.32 ± 0.21 p = 0.003), PAD (0.38 ± 0.19 vs. 0.32 ± 0.21; p = 0.011), TI (0.30 ± 0.11 vs. 0.27 ± 0.14; p = 0.034), and ICM (0.30 ± 0.16 vs. 0.22 ± 0.12; p < 0.001). We found that that patients who presented with a subarachnoid hemorrhage had significantly higher PAD (0.46 ± 0.22 vs. 0.35 ± 0.20; p = 0.024). In conclusion, higher tortuosity of ICA is associated with ICA aneurysm presence.
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202
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Tortuosity of the superficial femoral artery and its influence on blood flow patterns and risk of atherosclerosis. Biomech Model Mechanobiol 2019; 18:883-896. [DOI: 10.1007/s10237-019-01118-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 01/09/2019] [Indexed: 10/27/2022]
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203
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Hassan AK, Abd–El Rahman H, Hassan SG, Ahmed TA, Youssef AAA. Validity of tortuosity severity index in chest pain patients with abnormal exercise test and normal coronary angiography. Egypt Heart J 2018; 70:381-387. [PMID: 30591760 PMCID: PMC6303525 DOI: 10.1016/j.ehj.2018.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 07/14/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Coronary tortuosity (CT) had different definitions and scores in literature with unclear pathophysiological impact. OBJECTIVES To study degree of CT and it's relation to ischemic changes in patients with angina but normal coronary angiography (CA). METHODS We conducted a prospective study at University hospitals between May 2016 and January 2017. We included 200 consecutive patients who underwent CA due to chest pain assumed to be of cardiac origin, and their CA was normal (no diameter stenosis >30%, nor myocardial bridging). Patients were prospectively divided into 2 groups based on the presence (n = 113) or absence (n = 87) of ischemic changes during stress study and compared for clinical, echocardiographic and CA characteristics. A newly proposed Tortuosity Severity Index (TSI) was developed into significant (mild/moderate CT with more than 4 curvatures in total, or severe/extreme CT with any number of curvatures) or not significant TSI (mild CT with curvatures less than or equal to 4 curvatures in total). RESULTS Patients with ischemic changes had the highest rate of CT (76.5 vs 18%, p = 0.004) compared to those without. CT mostly affects the left anterior descending (LAD) coronary artery in mid and distal segments. Females, elderly, and hypertensives with left ventricular hypertrophy were strongly related to CT. Multivariate logistic regression analysis identified CT with significant TSI as the only predictor of ischemic changes in these patients (OR = 6.2, CI = 2.5-15.3, P = <0.001). CONCLUSIONS Coronary tortuosity is a strong predictor of anginal pain among patients with normal CA, despite positive stress study. This finding is more pronounced among elderly, hypertensive female patients.
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Affiliation(s)
- Ayman K.M. Hassan
- Department of Cardiology, Faculty of Medicine, Assiut University, Egypt
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204
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Ramos L, Novo J, Rouco J, Romeo S, Álvarez MD, Ortega M. Retinal vascular tortuosity assessment: inter-intra expert analysis and correlation with computational measurements. BMC Med Res Methodol 2018; 18:144. [PMID: 30458717 PMCID: PMC6245828 DOI: 10.1186/s12874-018-0598-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 10/30/2018] [Indexed: 01/20/2023] Open
Abstract
Background The retinal vascular tortuosity can be a potential indicator of relevant vascular and non-vascular diseases. However, the lack of a precise and standard guide for the tortuosity evaluation hinders its use for diagnostic and treatment purposes. This work aims to advance in the standardization of the retinal vascular tortuosity as a clinical biomarker with diagnostic potential, allowing, thereby, the validation of objective computational measurements on the basis of the entire spectrum of the expert knowledge. Methods This paper describes a multi-expert validation process of the computational vascular tortuosity measurements of reference. A group of five experts, covering the different clinical profiles of an ophthalmological service, and a four-grade scale from non-tortuous to severe tortuosity as well as non-tortuous / tortuous and asymptomatic / symptomatic binary classifications are considered for the analysis of the the multi-expert validation procedure. The specialists rating process comprises two rounds involving all the experts and a joint round to establish consensual rates. The expert agreement is analyzed throughout the rating procedure and, then, the consensual rates are set as the reference to validate the prognostic performance of four computational tortuosity metrics of reference. Results The Kappa indexes for the intra-rater agreement analysis were obtained between 0.35 and 0.83 whereas for the inter-rater agreement in the asymptomatic / symptomatic classification were between 0.22 and 0.76. The Area Under the Curve (AUC) for each expert against the consensual rates were placed between 0.61 and 0.83 whereas the prognostic performance of the best objective tortuosity metric was 0.80. Conclusions There is a high inter and intra-rater variability, especially for the case of the four grade scale. The prognostic performance of the tortuosity measurements is close to the experts’ performance, especially for Grisan measurement. However, there is a gap between the automatic effectiveness and the expert perception given the lack of clinical criteria in the computational measurements.
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Affiliation(s)
- Lucía Ramos
- University of A Coruña, Department of Computer Science, Campus de Elviña, A Coruña, 15071, Spain. .,CITIC-Research Center of Information and Communication Technologies, University of A Coruña, A Coruña, Spain.
| | - Jorge Novo
- University of A Coruña, Department of Computer Science, Campus de Elviña, A Coruña, 15071, Spain.,CITIC-Research Center of Information and Communication Technologies, University of A Coruña, A Coruña, Spain
| | - José Rouco
- University of A Coruña, Department of Computer Science, Campus de Elviña, A Coruña, 15071, Spain.,CITIC-Research Center of Information and Communication Technologies, University of A Coruña, A Coruña, Spain
| | - Stephanie Romeo
- Servizo de Oftalmoloxía, Complexo Hospitalario Universitario de Ferrol, Ferrol, A coruña, Spain
| | - María D Álvarez
- Servizo de Oftalmoloxía, Complexo Hospitalario Universitario de Ferrol, Ferrol, A coruña, Spain
| | - Marcos Ortega
- University of A Coruña, Department of Computer Science, Campus de Elviña, A Coruña, 15071, Spain.,CITIC-Research Center of Information and Communication Technologies, University of A Coruña, A Coruña, Spain
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205
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Tawfik AM, Sobh DM, Gadelhak B, Sobh HM, Batouty NM. The effect of age and gender on tortuosity of the descending thoracic Aorta. Eur J Radiol 2018; 110:54-59. [PMID: 30599873 DOI: 10.1016/j.ejrad.2018.11.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 09/15/2018] [Accepted: 11/19/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND To study the effect of age and gender on tortuosity of the descending thoracic aorta, and to evaluate inter-observer agreement of tortuosity index (TI) measurements. METHODS Contrast-enhanced CT scans of 182 patients were analyzed by an experienced radiologist using routine 3D imaging software. The descending aorta was defined by proximal and distal endpoints. The software generated centerline length, and straight line distance between the 2 endpoints were measured. TI was calculated as: [centerline length / straight line distance -1] * 100. Impact of age on TI of the descending aorta was assessed using linear regression in both genders. To assess inter-observer agreement; TI measurements of 50 cases were repeated by 3 other independent readers. RESULTS The mean (±SD) TI was 8.3 ± 2.6 in men and 8.9 ± 3 in women, with no significant difference between the 2 genders, p = 0.208. Moderate positive correlation was observed between TI and age (r = 0.566, p < 0.00001 and r = 0.569, p < 0.00001 in men and women, respectively). The 10-year-percent change was higher in women than men (13.3% and 9.5%, respectively). Inter-observer agreement for TI was good, intra-class correlation coefficient was 0.84 (95% CI: 0.76-0.89, p < 0.0001). Centerline length was poorly correlated to age (r = 0.248, p = 0.048 in men and r = 0.369, p < 0.001 in women). Body-surface-area-indexed centerline length was not significantly correlated to age (p = 0.948). CONCLUSIONS Tortuosity of the descending aorta increases with age in both genders. TI has acceptable inter-observer agreement and was better correlated to age than centerline length measurements.
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Affiliation(s)
- Ahmed M Tawfik
- Department of Diagnostic and Interventional Radiology, Mansoura University, Faculty of Medicine, 35112, 12 El-Gomhoreya Street, Mansoura, Egypt.
| | - Donia M Sobh
- Department of Diagnostic and Interventional Radiology, Mansoura University, Faculty of Medicine, 35112, 12 El-Gomhoreya Street, Mansoura, Egypt.
| | - Basma Gadelhak
- Department of Diagnostic and Interventional Radiology, Mansoura University, Faculty of Medicine, 35112, 12 El-Gomhoreya Street, Mansoura, Egypt.
| | - Hoda M Sobh
- Department of Cardiology, Mansoura University, Faculty of Medicine, 35112, 12 El-Gomhoreya Street, Mansoura, Egypt.
| | - Nihal M Batouty
- Department of Diagnostic and Interventional Radiology, Mansoura University, Faculty of Medicine, 35112, 12 El-Gomhoreya Street, Mansoura, Egypt.
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206
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Ezzeldin M, Youssef EW, Sultan-Qurraie A, Lin E, Zaidat OO. A Serpiginous Pericallosal Anterior Cerebral Artery. INTERVENTIONAL NEUROLOGY 2018; 7:323-326. [PMID: 30410508 DOI: 10.1159/000488600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 03/19/2018] [Indexed: 11/19/2022]
Abstract
The anterior cerebral artery (ACA) is a unique artery with many important variations with substantial clinical significance. Tortuous intracranial arteries usually occur in basilar, communicating, anterior, posterior cerebral arteries and in the white matter arterioles. This could happen for many reasons including but not limited to ageing, hypertension, patients with Moyamoya disease, congenital malformation, or increased flow associated with elastin degradation. While dolichoectasia of the ACA has been described even in children, to our knowledge, a serpiginous ACA without ectasia has not been reported, especially in the pediatric population.
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Affiliation(s)
- Mohamad Ezzeldin
- Interventional Neurology, Mercy Health St. Vincent Medical Center, Toledo, Ohio, USA
| | - Eslam W Youssef
- Department of Neurology, University of Toledo, Toledo, Ohio, USA
| | - Ali Sultan-Qurraie
- Interventional Neurology, Mercy Health St. Vincent Medical Center, Toledo, Ohio, USA
| | - Eugene Lin
- Interventional Neurology, Mercy Health St. Vincent Medical Center, Toledo, Ohio, USA
| | - Osama O Zaidat
- Interventional Neurology, Mercy Health St. Vincent Medical Center, Toledo, Ohio, USA
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207
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Arrigo A, Aragona E, Capone L, Pierro L, Romano F, Bandello F, Parodi MB. Advanced Optical Coherence Tomography Angiography Analysis of Age-related Macular Degeneration Complicated by Onset of Unilateral Choroidal Neovascularization. Am J Ophthalmol 2018; 195:233-242. [PMID: 30098346 DOI: 10.1016/j.ajo.2018.08.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 07/08/2018] [Accepted: 08/01/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE To analyze optical coherence tomography angiography (OCTA) quantitative features in patients affected by new-onset choroidal neovascularization (CNV) in 1 eye and early/intermediate age-related macular degeneration (AMD) in the fellow eye. DESIGN Case-control study. METHODS Setting: Clinical practice. STUDY POPULATION Thirty patients and 30 age-matched controls. OBSERVATION PROCEDURES Both cohorts underwent complete ophthalmologic examination, including best-corrected visual acuity (BCVA) measurement, biomicroscopy, fluorescein angiography (FA) and indocyanine green angiography (ICGA) examination, optical coherence tomography, and OCTA scans. The 1-way a test with Bonferroni correction was used to assess statistical significance and Tau Kendall's correlation analysis was performed. MAIN OUTCOME MEASURES BCVA, choroidal thickness, vessel density, vessel tortuosity, vessel dispersion. and vessel rarefaction. RESULTS Mean BCVA was 20/32 for CNV eyes and 20/20 for both fellow and control eyes. Choroidal thickness was 190.33 ± 63.98 μm for CNV eyes, 216.83 ± 50.31 μm for fellow eyes, and 310.52 ± 27.13 μm for controls. The quantitative analysis of retinal vessels revealed significant alterations, especially in the deep capillary plexus and radial peripapillary capillaries, both in CNV and in fellow eyes, compared with controls. In particular, decreased vessel density and tortuosity and increased dispersion and rarefaction were found. Several significant correlations were also found among the quantitative parameters adopted. CONCLUSIONS New postprocessing OCTA parameters are able to detect deep retinal vascular alterations quantitatively, in both CNV-affected and fellow eyes of patients with new-onset CNV. Further investigations are warranted in order to explore the validity of these new approaches on follow-up.
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208
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Krzyżewski RM, Kliś KM, Kwinta BM, Gackowska M, Stachura K, Starowicz-Filip A, Thompson A, Gąsowski J. Analysis of Anterior Cerebral Artery Tortuosity: Association with Anterior Communicating Artery Aneurysm Rupture. World Neurosurg 2018; 122:e480-e486. [PMID: 30366144 DOI: 10.1016/j.wneu.2018.10.086] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/11/2018] [Accepted: 10/15/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Many researchers have found a correlation between tortuous arteries and development of aneurysms in cerebral arteries. However, there are no studies analyzing the impact of tortuosity on risk of subarachnoid hemorrhage (SAH) occurrence. Therefore, we decided to determine whether tortuosity of the anterior cerebral artery can be related to the rupture of anterior communicating artery aneurysm and to severity and treatment outcome of SAH. METHODS We retrospectively analyzed anterior cerebral artery anatomy of 121 patients with anterior communicating artery aneurysms. From patients' medical records, we obtained their history including previous and current diseases and medications. For each patient we calculated relative length, sum of angle metrics, triangular index, product of angle distance, and inflection count metrics. RESULTS Patients with SAH had significantly higher relative length (0.70 ± 0.19 vs. 0.63 ± 0.22; P = 0.03) and significantly lower inflection count metrics (0.10 ± 0.08 vs. 0.16 ± 0.19; P < 0.01), respectively. In multivariate logistic regression analysis, after adjustment of all possible confounders, diabetes mellitus (odds ratio [OR], 0.154; 95% confidence interval [CI], 0.032-0.553; P < 0.01) and higher inflection count metrics (OR, 0.604; 95% CI, 0.357-0.909; P = 0.042) remained independently associated with lower risk of SAH. We also found an independent correlation between aneurysm dome size (R = -0.289; P = 0.02) and triangular index (R = 0.273; P = 0.03) and Glasgow Coma Scale score on admission. CONCLUSIONS Higher anterior cerebral artery tortuosity might be a protective factor against anterior communicating artery aneurysm rupture.
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Affiliation(s)
- Roger M Krzyżewski
- Department of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College, Kraków, Poland; TENSOR- Team of NeuroSurgery-Oriented Research, Jagiellonian University Medical College, Kraków, Poland.
| | - Kornelia M Kliś
- TENSOR- Team of NeuroSurgery-Oriented Research, Jagiellonian University Medical College, Kraków, Poland; Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland; AGH University of Science and Technology, Faculty of Computer Science, Electronics and Telecommunications, Kraków, Poland
| | - Borys M Kwinta
- Department of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College, Kraków, Poland
| | | | - Krzysztof Stachura
- Department of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College, Kraków, Poland
| | - Anna Starowicz-Filip
- Department of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College, Kraków, Poland
| | - Ashley Thompson
- Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Jerzy Gąsowski
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland; TENSOR- Team of NeuroSurgery-Oriented Research, Jagiellonian University Medical College, Kraków, Poland
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209
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Zhang J, Dashtbozorg B, Huang F, Tan T, ter Haar Romeny BM. A fully automated pipeline of extracting biomarkers to quantify vascular changes in retina-related diseases. COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING-IMAGING AND VISUALIZATION 2018. [DOI: 10.1080/21681163.2018.1519851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Jiong Zhang
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Behdad Dashtbozorg
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Fan Huang
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Tao Tan
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - B. M. ter Haar Romeny
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
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210
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Kaesmacher J, Gralla J, Mosimann PJ, Zibold F, Heldner MR, Piechowiak E, Dobrocky T, Arnold M, Fischer U, Mordasini P. Reasons for Reperfusion Failures in Stent-Retriever-Based Thrombectomy: Registry Analysis and Proposal of a Classification System. AJNR Am J Neuroradiol 2018; 39:1848-1853. [PMID: 30166434 DOI: 10.3174/ajnr.a5759] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 06/25/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE In 5%-10% of patients with acute ischemic stroke with an intention to treat with mechanical thrombectomy, no reperfusion can be achieved (Thrombolysis in Cerebral Infarction score = 0/1). Purpose of this analysis was a systematic assessment of underlying reasons for reperfusion failures. MATERIALS AND METHODS An intention-to-treat single-center cohort (n = 592) was re-evaluated for all patients in whom no reperfusion could be achieved (n = 63). Baseline characteristics of patients were compared between patients with and without reperfusion failures. After qualitative review of all cases with reperfusion failures, a classification system was proposed and relative frequencies were reported. In a second step, occurrence of delayed recanalization at 24 hours after reperfusion failure and dependency on IV-tPA were evaluated. RESULTS In 63/592 patients with an intention to perform stent-retriever thrombectomy, no reperfusion was achieved (TICI 0/1, 10.6%, 95% CI, 8.2%-13.1%). Older patients (adjusted OR per yr = 1.03; 95% CI, 1.01-1.05) and patients with M2 occlusion (adjusted OR = 3.36; 95% CI, 1.82-6.21) were at higher risk for reperfusion failure. In most cases, no reperfusion was a consequence of technical difficulties (56/63, 88.9%). In one-third of these cases, reperfusion failures were due to the inability to reach the target occlusion (20/63, 31.7%), while "stent-retriever failure" occurred in 39.7% (25/63) of patients. Delayed recanalization was very rare (18.2%), without dependence on IV-tPA pretreatment status. CONCLUSIONS Reasons for reperfusion failure in stent-retriever thrombectomy are heterogeneous. The failure to establish intracranial or cervical access is almost as common as stent-retriever failure after establishing intracranial access. Systematic reporting standards of reasons may help to further estimate relative frequencies and thereby guide priorities for technical development and scientific effort.
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Affiliation(s)
- J Kaesmacher
- From the University Institute of Diagnostic and Interventional Neuroradiology (J.K., J.G., P.J. Mosimann, F.Z., E.P., T.D., P. Mordasini)
- Department of Neurology (J.K., M.R.H., M.A., U.F.), University Hospital Bern and University of Bern, Inselspital, Bern, Switzerland
| | - J Gralla
- From the University Institute of Diagnostic and Interventional Neuroradiology (J.K., J.G., P.J. Mosimann, F.Z., E.P., T.D., P. Mordasini)
| | - P J Mosimann
- From the University Institute of Diagnostic and Interventional Neuroradiology (J.K., J.G., P.J. Mosimann, F.Z., E.P., T.D., P. Mordasini)
| | - F Zibold
- From the University Institute of Diagnostic and Interventional Neuroradiology (J.K., J.G., P.J. Mosimann, F.Z., E.P., T.D., P. Mordasini)
| | - M R Heldner
- Department of Neurology (J.K., M.R.H., M.A., U.F.), University Hospital Bern and University of Bern, Inselspital, Bern, Switzerland
| | - E Piechowiak
- From the University Institute of Diagnostic and Interventional Neuroradiology (J.K., J.G., P.J. Mosimann, F.Z., E.P., T.D., P. Mordasini)
| | - T Dobrocky
- From the University Institute of Diagnostic and Interventional Neuroradiology (J.K., J.G., P.J. Mosimann, F.Z., E.P., T.D., P. Mordasini)
| | - M Arnold
- Department of Neurology (J.K., M.R.H., M.A., U.F.), University Hospital Bern and University of Bern, Inselspital, Bern, Switzerland
| | - U Fischer
- Department of Neurology (J.K., M.R.H., M.A., U.F.), University Hospital Bern and University of Bern, Inselspital, Bern, Switzerland
| | - P Mordasini
- From the University Institute of Diagnostic and Interventional Neuroradiology (J.K., J.G., P.J. Mosimann, F.Z., E.P., T.D., P. Mordasini)
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211
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Ryu J, Kim BJ, Lee KM, Kim HG, Choi SK, Kim EJ, Lee SH, Chang DI, Kwun BD. Intracranial Arterial Tortuosity According to the Characteristics of Intracranial Aneurysms. World Neurosurg 2018; 120:e1185-e1192. [PMID: 30236811 DOI: 10.1016/j.wneu.2018.09.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 08/25/2018] [Accepted: 09/05/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Intracranial aneurysm (IA) is the leading cause of subarachnoid hemorrhage. The pathomechanisms of IA are poorly understood but can be related to arterial tortuosity resulting from underlying systemic factors leading to arterial wall weakening. We aimed to analyze the tortuosity of the intracranial artery in a cohort with IA, hypothesizing that the tortuosity of intracranial arteries differs depending on the characteristics of the IA. METHODS Patients with saccular IA were consecutively enrolled. Clinical factors and vascular tortuosity of the right and left middle cerebral arteries and basilar artery (BA) of all patients with IA were compared according to the characteristics of the IA: 1) ruptured versus unruptured, 2) multiple versus single, and 3) large (>5 cm) versus small (≤5 cm). Unruptured IAs were comparatively analyzed according to aneurysm size and aspect ratio, whereas ruptured IAs were analyzed according to aneurysm size. RESULTS Two hundred eighty-five patients were enrolled (mean age, 59 years; 71.2% women). The tortuosity of the BA was higher in the large IA group (5.63 ± 6.26; n = 133; P = 0.009), large unruptured IA group (6.64 ± 6.32; n = 53; P = 0.039), and large ruptured IA group (5.50 ± 6.52; n = 80; P = 0.033) compared with the small IA, small unruptured IA, and small ruptured IA group. In multivariate analysis, increased BA tortuosity was significantly associated with large IAs (β = 1.066; P = 0.008), unruptured large IAs (β = 1.077; P = 0.033), and ruptured large IAs (β = 1.086; P = 0.025). CONCLUSIONS The BA tortuosity was higher in patients with large IAs, which may represent an imaging biomarker of aneurysm growth.
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Affiliation(s)
- Jiwook Ryu
- Department of Neurosurgery, College of Medicine, Kyung Hee University, Kyung Hee University Hospital, Seoul, Korea
| | - Bum Joon Kim
- Department of Neurology, College of Medicine, Kyung Hee University, Kyung Hee University Hospital, Seoul, Korea
| | - Kyung Mi Lee
- Department of Radiology, College of Medicine, Kyung Hee University, Kyung Hee University Hospital, Seoul, Korea
| | - Hyug-Gi Kim
- Department of Radiology, College of Medicine, Kyung Hee University, Kyung Hee University Hospital, Seoul, Korea
| | - Seok Keun Choi
- Department of Neurosurgery, College of Medicine, Kyung Hee University, Kyung Hee University Hospital, Seoul, Korea
| | - Eui Jong Kim
- Department of Radiology, College of Medicine, Kyung Hee University, Kyung Hee University Hospital, Seoul, Korea
| | - Sung Ho Lee
- Department of Neurosurgery, College of Medicine, Kyung Hee University, Kyung Hee University Hospital, Seoul, Korea.
| | - Dae-Il Chang
- Department of Neurology, College of Medicine, Kyung Hee University, Kyung Hee University Hospital, Seoul, Korea
| | - Byung Duk Kwun
- Department of Neurosurgery, College of Medicine, Kyung Hee University, Kyung Hee University Hospital, Seoul, Korea
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Khosravani-Rudpishi M, Akhavan-Khaleghi N, Hosseinsabet A. Two-dimensional speckle-tracking echocardiographic evaluation of the longitudinal deformation of the left ventricular myocardium in patients with severe coronary artery tortuosity. JOURNAL OF CLINICAL ULTRASOUND : JCU 2018; 46:467-474. [PMID: 29683198 DOI: 10.1002/jcu.22597] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/15/2018] [Accepted: 03/28/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE Coronary artery tortuosity (CAT) is an anatomical condition in which epicardial coronary arteries have abnormal curves or spiral courses. Although correlated with higher rates of positive stress test, its effects on the myocardial function remain to be clearly defined. METHODS We included in this cross-sectional study and evaluated with 2D speckle-tracking echocardiography 40 consecutive patients admitted to our hospital for selective coronary angiography which showed severe CAT without significant epicardial coronary artery stenosis, and 40 consecutive subjects matched for age, hypertension, and diabetes in whom selective coronary angiography showed neither CAT nor significant epicardial coronary artery stenosis. RESULTS Systolic strain, strain rate, and early and late diastolic strain rates were not significantly different between the 2 groups, even after adjustment for potential confounding variables. CONCLUSION The 2D speckle-tracking echocardiography-derived indices of longitudinal deformation of the left ventricular myocardium were not significantly different between the patients with severe CAT and controls.
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Affiliation(s)
| | | | - Ali Hosseinsabet
- Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, I.R., Iran
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213
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Tarantino N, Santoro F, Guastafierro F, Di Martino LFM, Scarcia M, Ieva R, Ruggiero A, Cuculo A, Mariano E, Di Biase M, Brunetti ND. "Lambda-wave" ST-elevation is associated with severe prognosis in stress (takotsubo) cardiomyopathy. Ann Noninvasive Electrocardiol 2018; 23:e12581. [PMID: 29984535 DOI: 10.1111/anec.12581] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 05/23/2018] [Accepted: 06/05/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Persistent ST-segment elevation in acute coronary syndrome is associated with both short and long-term complications. By contrast, there is limited information about ST-elevation and its evolution during takotsubo (stress) cardiomyopathy (TTC). AIM To evaluate whether persistent downsloping ST-elevation in the early stages of TTC might correlate with short and long-term clinical events. METHODS One-hundred fifty-eight consecutive subjects with TTC were prospectively enrolled and assessed by electrocardiogram. Patients were classified in two groups according to the presence of downsloping ST-elevation ≥5 mm lasting at least 24 hr ("lambda-wave" ST-elevation group vs. without downsloping ST-elevation) in at least one/two contiguous leads. RESULTS Five (3.2%) patients, all female with a mean left ventricular ejection fraction 32 ± 5%, were included in the lambda-wave ST-elevation group. These patients were characterized by a higher prevalence of physical stressor (100% vs. 49%, p = 0.04) and higher admission and peak levels of troponin-I levels during hospitalization. Peak of ST-elevation in the lambda-wave ST-elevation group was reached 6 hr after admission and gradually decreased after 24 hr. In-hospital complications were observed in all the patients presenting lambda ST-elevation (100% vs. 23%, p = 0.03, OR: 29.1, p = 0.04); one patient presented endoventricular thrombosis and two died of cardiogenic shock. At long-term follow-up (mean 443 days), adverse events were observed in 80% of patients with lambda-wave ST-elevation (RR of adverse events at follow-up 32, p < 0.01). CONCLUSION Persistent downsloping lambda-wave ST-elevation during the acute phase of stress cardiomyopathy may be associated with a higher risk of adverse events at short and long-term follow-up.
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Affiliation(s)
- Nicola Tarantino
- Department of Medical and Surgery Science, University of Foggia, Foggia, Italy
| | - Francesco Santoro
- Department of Medical and Surgery Science, University of Foggia, Foggia, Italy.,Asklepios Klinik - St. Georg, Hamburg, Germany
| | | | | | - Maria Scarcia
- Department of Medical and Surgery Science, University of Foggia, Foggia, Italy
| | - Riccardo Ieva
- Department of Medical and Surgery Science, University of Foggia, Foggia, Italy
| | - Antonio Ruggiero
- Department of Medical and Surgery Science, University of Foggia, Foggia, Italy
| | - Andrea Cuculo
- Department of Medical and Surgery Science, University of Foggia, Foggia, Italy
| | - Enrica Mariano
- Department of Cardiology, University "Tor Vergata", Rome, Italy
| | - Matteo Di Biase
- Department of Medical and Surgery Science, University of Foggia, Foggia, Italy
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214
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Iroshan KA, De Zoysa ADN, Warnapura CL, Wijesuriya MA, Jayasinghe S, Nanayakkara ND, De Silval AC. Detection of Diabetes by Macrovascular Tortuosity of Superior Bulbar Conjunctiva. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2018:1-4. [PMID: 30440269 DOI: 10.1109/embc.2018.8512838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
More than 8% of world population have diabetes which causes long term complications such as retinopathy, neuropathy, nephropathy and foot ulcers. Growing patient numbers has prompted large scale screening methods to detect early symptoms of diabetes (rather than elevated blood glucose levels which is a late symptom). Vascular tortuosity (twisted and curved nature of blood vessels) in retinal fundus images has proven to reflect the effect of diabetes on macrovasculature. However, large scale patient screening using retinal fundus images has limitations due to the requirement of a retinal camera. Therefore, we hypothesize that the vasculature of superior bulbar conjunctiva which could be captured using a regular camera could be used to measure tortuosity instead of retinal fundus images enabling mass screening.To test this hypothesis, a total of 168 scleral images were acquired from 50 healthy subjects and 34 diabetic patients using a digital camera. The sclera region was segmented using Chan-Vese algorithm and macrovasculature of superior bulbar conjunctiva was segmented using B-COSFIRE filters. Results revealed that the superior bulbar conjunctival macrovascular tortuosity of diabetic patients was significantly less than that of non-diabetic group (p-value =0.015). A similar result was yielded (p-value =0.049) from a group of participants who were less than 40 years old which excluded the age related variation of tortuosity.
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215
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Huang F, Dashtbozorg B, Tan T, Ter Haar Romeny BM. Retinal artery/vein classification using genetic-search feature selection. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2018; 161:197-207. [PMID: 29852962 DOI: 10.1016/j.cmpb.2018.04.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 03/09/2018] [Accepted: 04/17/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND OBJECTIVES The automatic classification of retinal blood vessels into artery and vein (A/V) is still a challenging task in retinal image analysis. Recent works on A/V classification mainly focus on the graph analysis of the retinal vasculature, which exploits the connectivity of vessels to improve the classification performance. While they have overlooked the importance of pixel-wise classification to the final classification results. This paper shows that a complicated feature set is efficient for vessel centerline pixels classification. METHODS We extract enormous amount of features for vessel centerline pixels, and apply a genetic-search based feature selection technique to obtain the optimal feature subset for A/V classification. RESULTS The proposed method achieves an accuracy of 90.2%, the sensitivity of 89.6%, the specificity of 91.3% on the INSPIRE dataset. It shows that our method, using only the information of centerline pixels, gives a comparable performance as the techniques which use complicated graph analysis. In addition, the results on the images acquired by different fundus cameras show that our framework is capable for discriminating vessels independent of the imaging device characteristics, image resolution and image quality. CONCLUSION The complicated feature set is essential for A/V classification, especially on the individual vessels where graph-based methods receive limitations. And it could provide a higher entry to the graph-analysis to achieve a better A/V labeling.
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Affiliation(s)
- Fan Huang
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Behdad Dashtbozorg
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Tao Tan
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Mammography, ScreenPoint Medical, Nijmegen, The Netherlands
| | - Bart M Ter Haar Romeny
- Department of Biomedical and Information Engineering, Northeastern University, Shenyang, China; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
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216
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Li Y, Choi WJ, Wei W, Song S, Zhang Q, Liu J, Wang RK. Aging-associated changes in cerebral vasculature and blood flow as determined by quantitative optical coherence tomography angiography. Neurobiol Aging 2018; 70:148-159. [PMID: 30007164 DOI: 10.1016/j.neurobiolaging.2018.06.017] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 06/14/2018] [Accepted: 06/14/2018] [Indexed: 01/29/2023]
Abstract
Normal aging is associated with significant alterations in brain's vascular structure and function, which can lead to compromised cerebral circulation and increased risk of neurodegeneration. The in vivo examination of cerebral blood flow (CBF), including capillary beds, in aging brains with sufficient spatial detail remains challenging with current imaging modalities. In the present study, we use 3-dimensional (3-D) quantitative optical coherence tomography angiography (OCTA) to examine characteristic differences of the cerebral vasculatures and hemodynamics at the somatosensory cortex between old (16 months old) and young mice (2 months old) in vivo. The quantitative metrics include cortical vascular morphology, CBF, and capillary flow velocity. We show that compared with young mice, the pial arterial tortuosity increases by 14%, the capillary vessel density decreases by 15%, and the CBF reduces by 33% in the old mice. Most importantly, changes in capillary velocity and heterogeneity with aging are quantified for the first time with sufficiently high statistical power between young and old populations, with a 21% (p < 0.05) increase in capillary mean velocity and 19% (p ≤ 0.05) increase in velocity heterogeneity in the latter. Our findings through noninvasive imaging are in line with previous studies of vascular structure modification with aging, with additional quantitative assessment in capillary velocity enabled by advanced OCTA algorithms on a single imaging platform. The results offer OCTA as a promising neuroimaging tool to study vascular aging, which may shed new light on the investigations of vascular factors contributing to the pathophysiology of age-related neurodegenerative disorders.
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Affiliation(s)
- Yuandong Li
- Department of Bioengineering, College of Engineering and School of Medicine, University of Washington, Seattle, WA, USA
| | - Woo June Choi
- Department of Bioengineering, College of Engineering and School of Medicine, University of Washington, Seattle, WA, USA; School of Electrical and Electronics Engineering, College of ICT Engineering, Chung-Ang University, Seoul, Korea
| | - Wei Wei
- Department of Bioengineering, College of Engineering and School of Medicine, University of Washington, Seattle, WA, USA
| | - Shaozhen Song
- Department of Bioengineering, College of Engineering and School of Medicine, University of Washington, Seattle, WA, USA
| | - Qinqin Zhang
- Department of Bioengineering, College of Engineering and School of Medicine, University of Washington, Seattle, WA, USA
| | - Jialing Liu
- Department of Neurological Surgery, University of California, San Francisco and SFVAMC, San Francisco, CA, USA
| | - Ruikang K Wang
- Department of Bioengineering, College of Engineering and School of Medicine, University of Washington, Seattle, WA, USA.
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217
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Yu J, Zhang S, Li ML, Ma Y, Dong YR, Lou M, Feng F, Gao S, Wu SW, Xu WH. Relationship between the geometry patterns of vertebrobasilar artery and atherosclerosis. BMC Neurol 2018; 18:83. [PMID: 29895279 PMCID: PMC5996488 DOI: 10.1186/s12883-018-1084-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 05/30/2018] [Indexed: 12/20/2022] Open
Abstract
Background The plaques at the dorsal or lateral wall of basilar artery (BA) are associated with pontine infarcts. We sought to explore the correlations between vertebrobasilar artery geometry and BA plaque locations. Methods We retrospectively analyzed the imaging and clinical data of 84 patients with BA atherosclerosis. On three-dimensional time-of-flight images, a side to side diameter difference of bilateral vertebral artery (VA) and BA bending were assessed. The vertebrobasilar artery geometry was qualitatively classified into four basic configurations: Walking, Tuning Fork, Dominant-Lambda, and Hypoplasia-Lambda. On high-resolution magnetic resonance imaging, the plaques were categorized based on the involvement of the ventral, dorsal, or lateral sides of BA wall. The relationships between vertebrobasilar artery geometry parameters and plaque locations were analyzed. Results Left VA dominance was identified in 28(33%) patients, and right VA dominance in 22(26%) patients. BA bending were detected in 49 patients. There were no significant correlations between the diameter difference/ratio of VA diameters and plaque locations, or between BA bending and plaque locations. BA plaques were evenly distributed in the vertebrobasilar arteries with Tuning Fork and Dominant-Lambda configurations. In Hypoplasia-Lambda group, however, plaques were more frequently located at the dorsal wall (58.57%) than at the ventral (14.43%) and lateral wall (26.71%; P = 0.001). In Walking group, the plaques more likely occurred at the lateral (49.79%) and dorsal (35.07%) wall than at the ventral wall (14.86%, P = 0.02). Conclusions The geometric configurations of vertebrobasilar artery strongly influence the BA plaque locations. Further prospective studies are warranted to testify whether Hypoplasia-Lambda and Walking configurations are independent risk factors for pontine infarcts. Electronic supplementary material The online version of this article (10.1186/s12883-018-1084-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jin Yu
- Department of Neurology and Radiology, General Hospital of Chinese People's Armed Police Forces, 69 Yongding road, Haidian District, Beijing, 100039, China
| | - Shu Zhang
- Department of Neurology and Radiology, General Hospital of Chinese People's Armed Police Forces, 69 Yongding road, Haidian District, Beijing, 100039, China
| | - Ming-Li Li
- Department of Neurology and Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1, Dongcheng District, Beijing, 100730, China
| | - Yi Ma
- Department of Neurology and Radiology, General Hospital of Chinese People's Armed Police Forces, 69 Yongding road, Haidian District, Beijing, 100039, China
| | - Yu-Ru Dong
- Department of Neurology and Radiology, General Hospital of Chinese People's Armed Police Forces, 69 Yongding road, Haidian District, Beijing, 100039, China
| | - Min Lou
- Department of Neurology, Zhejiang University 2nd Affiliate Hospital, Hangzhou, Zhejiang Province, China
| | - Feng Feng
- Department of Neurology and Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1, Dongcheng District, Beijing, 100730, China
| | - Shan Gao
- Department of Neurology and Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1, Dongcheng District, Beijing, 100730, China
| | - Shi-Wen Wu
- Department of Neurology and Radiology, General Hospital of Chinese People's Armed Police Forces, 69 Yongding road, Haidian District, Beijing, 100039, China.
| | - Wei-Hai Xu
- Department of Neurology and Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1, Dongcheng District, Beijing, 100730, China.
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218
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Harput S, Christensen-Jeffries K, Brown J, Li Y, Williams KJ, Davies AH, Eckersley RJ, Dunsby C, Tang MX, Christensen-Jeffries K, Li Y, Williams KJ, Eckersley RJ, Harput S, Dunsby C, Davies AH, Brown J, Tang MX. Two-Stage Motion Correction for Super-Resolution Ultrasound Imaging in Human Lower Limb. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2018; 65:803-814. [PMID: 29733283 DOI: 10.1109/tuffc.2018.2824846] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The structure of microvasculature cannot be resolved using conventional ultrasound (US) imaging due to the fundamental diffraction limit at clinical US frequencies. It is possible to overcome this resolution limitation by localizing individual microbubbles through multiple frames and forming a superresolved image, which usually requires seconds to minutes of acquisition. Over this time interval, motion is inevitable and tissue movement is typically a combination of large- and small-scale tissue translation and deformation. Therefore, super-resolution (SR) imaging is prone to motion artifacts as other imaging modalities based on multiple acquisitions are. This paper investigates the feasibility of a two-stage motion estimation method, which is a combination of affine and nonrigid estimation, for SR US imaging. First, the motion correction accuracy of the proposed method is evaluated using simulations with increasing complexity of motion. A mean absolute error of 12.2 was achieved in simulations for the worst-case scenario. The motion correction algorithm was then applied to a clinical data set to demonstrate its potential to enable in vivo SR US imaging in the presence of patient motion. The size of the identified microvessels from the clinical SR images was measured to assess the feasibility of the two-stage motion correction method, which reduced the width of the motion-blurred microvessels to approximately 1.5-fold.
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219
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Cristante E, Liyanage SE, Sampson RD, Kalargyrou A, De Rossi G, Rizzi M, Hoke J, Ribeiro J, Maswood RN, Duran Y, Matsuki T, Aghaizu ND, Luhmann UF, Smith AJ, Ali RR, Bainbridge JWB. Late neuroprogenitors contribute to normal retinal vascular development in a Hif2a-dependent manner. Development 2018; 145:dev.157511. [PMID: 29615467 DOI: 10.1242/dev.157511] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 03/20/2018] [Indexed: 12/20/2022]
Abstract
In the adult central nervous system, endothelial and neuronal cells engage in tight cross-talk as key components of the so-called neurovascular unit. Impairment of this important relationship adversely affects tissue homeostasis, as observed in neurodegenerative conditions including Alzheimer's and Parkinson's disease. In development, the influence of neuroprogenitor cells on angiogenesis is poorly understood. Here, we show in mouse that these cells interact intimately with the growing retinal vascular network, and we identify a novel regulatory mechanism of vasculature development mediated by hypoxia-inducible factor 2a (Hif2a). By Cre-lox gene excision, we show that Hif2a in retinal neuroprogenitor cells upregulates the expression of the pro-angiogenic mediators vascular endothelial growth factor and erythropoietin, whereas it locally downregulates the angiogenesis inhibitor endostatin. Importantly, absence of Hif2a in retinal neuroprogenitor cells causes a marked reduction of proliferating endothelial cells at the angiogenic front. This results in delayed retinal vascular development, fewer major retinal vessels and reduced density of the peripheral deep retinal vascular plexus. Our findings demonstrate that retinal neuroprogenitor cells are a crucial component of the developing neurovascular unit.
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Affiliation(s)
- Enrico Cristante
- UCL Institute of Ophthalmology, 11-43 Bath Street, London EC1V 9EL, UK .,NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, City Road, London EC1V 2PD, UK
| | - Sidath E Liyanage
- UCL Institute of Ophthalmology, 11-43 Bath Street, London EC1V 9EL, UK.,NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, City Road, London EC1V 2PD, UK
| | - Robert D Sampson
- UCL Institute of Ophthalmology, 11-43 Bath Street, London EC1V 9EL, UK
| | | | - Giulia De Rossi
- Centre for Microvascular Research, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Matteo Rizzi
- UCL Institute of Ophthalmology, 11-43 Bath Street, London EC1V 9EL, UK.,NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, City Road, London EC1V 2PD, UK
| | - Justin Hoke
- UCL Institute of Ophthalmology, 11-43 Bath Street, London EC1V 9EL, UK
| | - Joana Ribeiro
- UCL Institute of Ophthalmology, 11-43 Bath Street, London EC1V 9EL, UK
| | - Ryea N Maswood
- UCL Institute of Ophthalmology, 11-43 Bath Street, London EC1V 9EL, UK
| | - Yanai Duran
- UCL Institute of Ophthalmology, 11-43 Bath Street, London EC1V 9EL, UK
| | - Takaaki Matsuki
- UCL Institute of Ophthalmology, 11-43 Bath Street, London EC1V 9EL, UK
| | - Nozie D Aghaizu
- UCL Institute of Ophthalmology, 11-43 Bath Street, London EC1V 9EL, UK
| | - Ulrich F Luhmann
- UCL Institute of Ophthalmology, 11-43 Bath Street, London EC1V 9EL, UK.,NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, City Road, London EC1V 2PD, UK
| | - Alexander J Smith
- UCL Institute of Ophthalmology, 11-43 Bath Street, London EC1V 9EL, UK
| | - Robin R Ali
- UCL Institute of Ophthalmology, 11-43 Bath Street, London EC1V 9EL, UK.,NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, City Road, London EC1V 2PD, UK
| | - James W B Bainbridge
- UCL Institute of Ophthalmology, 11-43 Bath Street, London EC1V 9EL, UK .,NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, City Road, London EC1V 2PD, UK
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220
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Sharawat IK, Suthar R, Vyas S, Rawat A, Sankhyan N. Mystery Case: Tortuous hairs and tortuous blood vessels. Neurology 2018; 90:e1174-e1176. [PMID: 29581334 DOI: 10.1212/wnl.0000000000005208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Indar Kumar Sharawat
- From the Department of Pediatrics, Advanced Pediatrics Centre (I.K.S., R.S., A.R., N.S.), and Department of Radiodiagnosis and Interventional Radiology (S.V.), Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Renu Suthar
- From the Department of Pediatrics, Advanced Pediatrics Centre (I.K.S., R.S., A.R., N.S.), and Department of Radiodiagnosis and Interventional Radiology (S.V.), Post Graduate Institute of Medical Education & Research, Chandigarh, India.
| | - Sameer Vyas
- From the Department of Pediatrics, Advanced Pediatrics Centre (I.K.S., R.S., A.R., N.S.), and Department of Radiodiagnosis and Interventional Radiology (S.V.), Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Amit Rawat
- From the Department of Pediatrics, Advanced Pediatrics Centre (I.K.S., R.S., A.R., N.S.), and Department of Radiodiagnosis and Interventional Radiology (S.V.), Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Naveen Sankhyan
- From the Department of Pediatrics, Advanced Pediatrics Centre (I.K.S., R.S., A.R., N.S.), and Department of Radiodiagnosis and Interventional Radiology (S.V.), Post Graduate Institute of Medical Education & Research, Chandigarh, India
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221
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Popovic N, Radunovic M, Badnjar J, Popovic T. Fractal dimension and lacunarity analysis of retinal microvascular morphology in hypertension and diabetes. Microvasc Res 2018; 118:36-43. [PMID: 29476757 DOI: 10.1016/j.mvr.2018.02.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 02/18/2018] [Accepted: 02/19/2018] [Indexed: 01/09/2023]
Abstract
Hypertension and diabetes mellitus represent modifiable risk factors for vascular disease. They cause microvascular remodeling, and ultimately result in end-organ damage. Therefore, development of methods for noninvasive quantification of the effects of hypertension and diabetes mellitus on microvasculature is of paramount importance. The two goals of the study were: 1) to characterize the geometric complexity and inhomogeneity of retinal vasculature in hypertensive retinopathy (HR) and in proliferative diabetic retinopathy (PDR) by using box counting fractal dimension and lacunarity analysis, and 2) to determine if the combination of these two parameters can be used to describe differences in the vascular tree geometry between HR and PDR. The extended set of retinal images from the publicly available STARE database was manually segmented by our expert, validated, and made available for other researchers to use. The healthy retinal vascular network has a higher complexity (fractal dimension) compared to that in HR and in PDR. However, there is no difference in microvascular complexity between HR and PDR. The inhomogeneity of the retinal microvascular tree (lacunarity) was higher in PDR compared to HR. Lacunarity and fractal dimension together quantitatively characterize microvascular geometry in the retina with higher specificity than fractal analysis alone.
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Affiliation(s)
- Natasa Popovic
- Faculty of Medicine, University of Montenegro, Podgorica, Montenegro.
| | | | - Jelena Badnjar
- Faculty for Information Systems and Technologies, University of Donja Gorica, Podgorica, Montenegro
| | - Tomo Popovic
- Faculty for Information Systems and Technologies, University of Donja Gorica, Podgorica, Montenegro
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222
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Sharzehee M, Khalafvand SS, Han HC. Fluid-structure interaction modeling of aneurysmal arteries under steady-state and pulsatile blood flow: a stability analysis. Comput Methods Biomech Biomed Engin 2018; 21:219-231. [PMID: 29446991 PMCID: PMC5879495 DOI: 10.1080/10255842.2018.1439478] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Tortuous aneurysmal arteries are often associated with a higher risk of
rupture but the mechanism remains unclear. The goal of this study was to analyze
the buckling and post-buckling behaviors of aneurysmal arteries under pulsatile
flow. To accomplish this goal, we analyzed the buckling behavior of model
carotid and abdominal aorta with aneurysms by utilizing fluid-structure
interaction (FSI) method with realistic waveforms boundary conditions. FSI
simulations were done under steady-state and pulsatile flow for normal (1.5) and
reduced (1.3) axial stretch ratios to investigate the influence of aneurysm,
pulsatile lumen pressure and axial tension on stability. Our results indicated
that aneurysmal artery buckled at the critical buckling pressure and its
deflection nonlinearly increased with increasing lumen pressure. Buckling
elevates the peak stress (up to 118%). The maximum aneurysm wall stress
at pulsatile FSI flow was (29%) higher than under static pressure at the
peak lumen pressure of 130 mmHg. Buckling results show an increase in lumen
shear stress at the inner side of the maximum deflection. Vortex flow was
dramatically enlarged with increasing lumen pressure and artery diameter.
Aneurysmal arteries are more susceptible than normal arteries to mechanical
instability which causes high stresses in the aneurysm wall that could lead to
aneurysm rupture.
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Affiliation(s)
- Mohammadali Sharzehee
- a Department of Mechanical Engineering , The University of Texas at San Antonio , San Antonio , TX , USA
| | | | - Hai-Chao Han
- a Department of Mechanical Engineering , The University of Texas at San Antonio , San Antonio , TX , USA
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223
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Liu Y, Xu P, Liang Z, Xie R, Ding M, Liu H, Liang Q. Hydrogel microfibers with perfusable folded channels for tissue constructs with folded morphology. RSC Adv 2018; 8:23475-23480. [PMID: 35540297 PMCID: PMC9081586 DOI: 10.1039/c8ra04192j] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 04/04/2019] [Accepted: 06/22/2018] [Indexed: 12/29/2022] Open
Abstract
Perfusable microfibers with folded channels are generated to fabricate small intestine and skeletal muscle constructs for tissue engineering.
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Affiliation(s)
- Yupeng Liu
- MOE Key Laboratory Bioorganic Phosphorous Chemistry & Chemical Biology
- Beijing Key Laboratory of Microanalytical Methods & Instrumentation
- Department of Chemistry
- Tsinghua University
- Beijing
| | - Peidi Xu
- MOE Key Laboratory Bioorganic Phosphorous Chemistry & Chemical Biology
- Beijing Key Laboratory of Microanalytical Methods & Instrumentation
- Department of Chemistry
- Tsinghua University
- Beijing
| | - Zhe Liang
- MOE Key Laboratory Bioorganic Phosphorous Chemistry & Chemical Biology
- Beijing Key Laboratory of Microanalytical Methods & Instrumentation
- Department of Chemistry
- Tsinghua University
- Beijing
| | - Ruoxiao Xie
- MOE Key Laboratory Bioorganic Phosphorous Chemistry & Chemical Biology
- Beijing Key Laboratory of Microanalytical Methods & Instrumentation
- Department of Chemistry
- Tsinghua University
- Beijing
| | - Mingyu Ding
- MOE Key Laboratory Bioorganic Phosphorous Chemistry & Chemical Biology
- Beijing Key Laboratory of Microanalytical Methods & Instrumentation
- Department of Chemistry
- Tsinghua University
- Beijing
| | - Hongxia Liu
- The State Key Laboratory of Chemical Oncogenomics
- The Graduate School at Shenzhen
- Tsinghua University
- Shenzhen 518055
- China
| | - Qionglin Liang
- MOE Key Laboratory Bioorganic Phosphorous Chemistry & Chemical Biology
- Beijing Key Laboratory of Microanalytical Methods & Instrumentation
- Department of Chemistry
- Tsinghua University
- Beijing
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Edroos SA, Sayer JW. Artefactual angulated lesion on angiography: A case report and review of literature. World J Cardiol 2017; 9:838-841. [PMID: 29317990 PMCID: PMC5746626 DOI: 10.4330/wjc.v9.i12.838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 11/20/2017] [Accepted: 12/04/2017] [Indexed: 02/06/2023] Open
Abstract
We present a case of a patient who presented with chest pain, and on diagnostic coronary angiography appeared to have a grossly angulated yet significant coronary stenosis. This was proven to be an artefactual appearance on further assessment with intravascular ultrasound imaging. We describe the causes and associations of coronary tortuosity with other arteriopathy, and highlight challenges in the interpretation of tortuous vessels to accurately assess luminal narrowing and suitability for coronary intervention. We describe a case of artefactual coronary stenosis, and its thorough assessment with intravascular ultrasound. A literature review describes the pathogenesis of coronary tortuosity, and links with other cardiovascular disease. Readers will gain an understanding of the challenge in determining the severity of luminal stenosis based on coronary angiography alone in tortuous coronary anatomy, the use of intravascular ultrasound in this setting, and the allied vasculopathies of interest.
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Affiliation(s)
- Sadat Ali Edroos
- Department of Cardiology, the Essex Cardiothoracic Centre, Basildon ESSEX SS16, United Kingdom
| | - Jeremy William Sayer
- Department of Cardiology, the Essex Cardiothoracic Centre, Basildon ESSEX SS16, United Kingdom
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225
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Chang JM, Zeng H, Han R, Chang YM, Shah R, Salafia CM, Newschaffer C, Miller RK, Katzman P, Moye J, Fallin M, Walker CK, Croen L. Autism risk classification using placental chorionic surface vascular network features. BMC Med Inform Decis Mak 2017; 17:162. [PMID: 29212472 PMCID: PMC5719902 DOI: 10.1186/s12911-017-0564-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 11/21/2017] [Indexed: 11/10/2022] Open
Abstract
Background Autism Spectrum Disorder (ASD) is one of the fastest-growing developmental disorders in the United States. It was hypothesized that variations in the placental chorionic surface vascular network (PCSVN) structure may reflect both the overall effects of genetic and environmentally regulated variations in branching morphogenesis within the conceptus and the fetus’ vital organs. This paper provides sound evidences to support the study of ASD risks with PCSVN through a combination of feature-selection and classification algorithms. Methods Twenty eight arterial and 8 shape-based PCSVN attributes from a high-risk ASD cohort of 89 placentas and a population-based cohort of 201 placentas were examined for ranked relevance using a modified version of the random forest algorithm, called the Boruta method. Principal component analysis (PCA) was applied to isolate principal effects of arterial growth on the fetal surface of the placenta. Linear discriminant analysis (LDA) with a 10-fold cross validation was performed to establish error statistics. Results The Boruta method selected 15 arterial attributes as relevant, implying the difference in high and low ASD risk can be explained by the arterial features alone. The five principal features obtained through PCA, which accounted for about 88% of the data variability, indicated that PCSVNs associated with placentas of high-risk ASD pregnancies generally had fewer branch points, thicker and less tortuous arteries, better extension to the surface boundary, and smaller branch angles than their population-based counterparts. Conclusion We developed a set of methods to explain major PCSVN differences between placentas associated with high risk ASD pregnancies and those selected from the general population. The research paradigm presented can be generalized to study connections between PCSVN features and other maternal and fetal outcomes such as gestational diabetes and hypertension.
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Affiliation(s)
- Jen-Mei Chang
- Department of Mathematics and Statistics, California State University, Long Beach, Long Beach, CA 90840-1001, USA.
| | - Hui Zeng
- Department of Mathematics and Statistics, California State University, Long Beach, Long Beach, CA 90840-1001, USA
| | - Ruxu Han
- Department of Mathematics and Statistics, California State University, Long Beach, Long Beach, CA 90840-1001, USA
| | - Ya-Mei Chang
- Department of Statistics, Tamkang University, No.151, Yingzhuan Rd., New Taipei City, 25137, Taiwan
| | - Ruchit Shah
- Placental Analytics, LLC, New Rochelle, NY, USA
| | - Carolyn M Salafia
- Placental Analytics, LLC, New Rochelle, NY, USA.,Institute for Basic Research, Staten Island, NY, USA.,NIH National Children's Study Placenta Consortium, Bethesda, MD, USA
| | | | - Richard K Miller
- NIH National Children's Study Placenta Consortium, Bethesda, MD, USA.,University of Rochester, Rochester, NY, USA
| | - Philip Katzman
- NIH National Children's Study Placenta Consortium, Bethesda, MD, USA.,University of Rochester, Rochester, NY, USA
| | | | | | - Cheryl K Walker
- NIH National Children's Study Placenta Consortium, Bethesda, MD, USA.,University of California Davis, Davis, CA, USA
| | - Lisa Croen
- NIH National Children's Study Placenta Consortium, Bethesda, MD, USA.,Kaiser Permenante Division of Research, Oakland, CA, USA
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226
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Gama Sosa MA, De Gasperi R, Perez Garcia GS, Sosa H, Searcy C, Vargas D, Janssen PL, Perez GM, Tschiffely AE, Janssen WG, McCarron RM, Hof PR, Haghighi FG, Ahlers ST, Elder GA. Lack of chronic neuroinflammation in the absence of focal hemorrhage in a rat model of low-energy blast-induced TBI. Acta Neuropathol Commun 2017; 5:80. [PMID: 29126430 PMCID: PMC6389215 DOI: 10.1186/s40478-017-0483-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 10/17/2017] [Indexed: 11/10/2022] Open
Abstract
Blast-related traumatic brain injury (TBI) has been a common cause of injury in the recent conflicts in Iraq and Afghanistan. Blast waves can damage blood vessels, neurons, and glial cells within the brain. Acutely, depending on the blast energy, blast wave duration, and number of exposures, blast waves disrupt the blood-brain barrier, triggering microglial activation and neuroinflammation. Recently, there has been much interest in the role that ongoing neuroinflammation may play in the chronic effects of TBI. Here, we investigated whether chronic neuroinflammation is present in a rat model of repetitive low-energy blast exposure. Six weeks after three 74.5-kPa blast exposures, and in the absence of hemorrhage, no significant alteration in the level of microglia activation was found. At 6 weeks after blast exposure, plasma levels of fractalkine, interleukin-1β, lipopolysaccharide-inducible CXC chemokine, macrophage inflammatory protein 1α, and vascular endothelial growth factor were decreased. However, no differences in cytokine levels were detected between blast-exposed and control rats at 40 weeks. In brain, isolated changes were seen in levels of selected cytokines at 6 weeks following blast exposure, but none of these changes was found in both hemispheres or at 40 weeks after blast exposure. Notably, one animal with a focal hemorrhagic tear showed chronic microglial activation around the lesion 16 weeks post-blast exposure. These findings suggest that focal hemorrhage can trigger chronic focal neuroinflammation following blast-induced TBI, but that in the absence of hemorrhage, chronic neuroinflammation is not a general feature of low-level blast injury.
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Affiliation(s)
- Miguel A Gama Sosa
- General Medical Research Service, James J. Peters Department of Veterans Affairs Medical Center, 130 West Kingsbridge Road, Bronx, New York, 10468, USA.
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Rita De Gasperi
- Research and Development Service, James J. Peters Department of Veterans Affairs Medical Center, Bronx, New York, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Georgina S Perez Garcia
- Research and Development Service, James J. Peters Department of Veterans Affairs Medical Center, Bronx, New York, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Heidi Sosa
- Research and Development Service, James J. Peters Department of Veterans Affairs Medical Center, Bronx, New York, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Courtney Searcy
- Research and Development Service, James J. Peters Department of Veterans Affairs Medical Center, Bronx, New York, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Danielle Vargas
- Research and Development Service, James J. Peters Department of Veterans Affairs Medical Center, Bronx, New York, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Pierce L Janssen
- Research and Development Service, James J. Peters Department of Veterans Affairs Medical Center, Bronx, New York, USA
- Fishberg Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gissel M Perez
- Research and Development Service, James J. Peters Department of Veterans Affairs Medical Center, Bronx, New York, USA
| | - Anna E Tschiffely
- Operational and Undersea Medicine Directorate, Naval Medical Research Center, Silver Spring, MD, USA
| | - William G Janssen
- Fishberg Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Richard M McCarron
- Operational and Undersea Medicine Directorate, Naval Medical Research Center, Silver Spring, MD, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Patrick R Hof
- Fishberg Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Geriatrics and Palliative Care, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Fatemeh G Haghighi
- Research and Development Service, James J. Peters Department of Veterans Affairs Medical Center, Bronx, New York, USA
- Fishberg Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stephen T Ahlers
- Operational and Undersea Medicine Directorate, Naval Medical Research Center, Silver Spring, MD, USA
| | - Gregory A Elder
- Neurology Service, James J. Peters Department of Veterans Affairs Medical Center, Bronx, New York, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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227
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Wen D, Zhao H, Duan W, An R, Li J, Zheng M. Combined CT angiography of the aorta and craniocervical artery: a new imaging protocol for assessment of acute type A aortic dissection. J Thorac Dis 2017; 9:4733-4742. [PMID: 29268544 DOI: 10.21037/jtd.2017.09.28] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background To investigate the feasibility of combined computed tomography angiography (CTA) of the aorta and craniocervical artery in acute type A aortic dissection (ATAAD) and the value of incremental craniocervical information. Methods Combined CTA of head, neck and aorta was performed in patients with suspected aortic dissection and 243 ATAAD patients were analyzed. The image quality and radiation dose were assessed. Valuable craniocervical CTA findings were determined for further surgical analysis. Results The mean dose-length product (DLP) was 314.11±29.31 mGy.cm. The image quality of craniocervical arteries were 100% diagnostic. Intimal flap involving carotid arteries was detected in 47% of patients, and significant stenosis of true lumen was observed in 60% of common carotid arteries (CCAs). Hypodensity and hypoplasia/occlusion of carotid arteries were also detected and apprised surgeons. The tortuosity of carotid artery was found in 90.9% of patients. Bilateral antegrade selective cerebral perfusion (ASCP) was performed in 21.1% of aortic arch surgery based on 7 hemodynamic variation types of the circle of Willis (CW) determined by cranial CTA information. Conclusions A combined CTA of head, neck and aorta is feasible with low radiation dose and diagnostic image quality. Incremental information on craniocervical pathology and anatomy may be useful for surgery repair of ATAAD.
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Affiliation(s)
- Didi Wen
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Hongliang Zhao
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Weixun Duan
- Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Rui An
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Jian Li
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Minwen Zheng
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
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228
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Imaging in cutis laxa syndrome caused by a dominant negative ALDH18A1 mutation, with hypotheses for intracranial vascular tortuosity and wide perivascular spaces. Eur J Paediatr Neurol 2017; 21:912-920. [PMID: 28757335 DOI: 10.1016/j.ejpn.2017.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 07/07/2017] [Accepted: 07/09/2017] [Indexed: 01/09/2023]
Abstract
The autosomal dominant progeroid form of cutis laxa is a recently identified multiple congenital anomaly disorder characterized by thin, wrinkled skin, a progeroid appearance, intra-uterine growth retardation, postnatal growth restriction, psychomotor developmental delay, microcephaly, cataract, hypotonia and contractures. De novo heterozygous mutations in ALDH18A1 have been described in this condition. We present neuroimaging abnormalities in three patients. One patient had intracranial arterial and venous tortuosity, widened ventricular and extra-axial cerebrospinal fluid (CSF) spaces, wide perivascular spaces and increased T2 signal intensity in the cerebral white matter over time. The second patient had vascular tortuosity. The third patient had prominent ventricular and extra-axial cerebrospinal fluid (CSF) spaces on CT. We propose an embryological mechanism for the development of intracranial vascular tortuosity and discuss the anatomical basis of wide perivascular spaces in relation to this syndrome. Although we do not know the clinical implications of these cerebral vascular anomalies, we suggest inclusion of neuroimaging in the baseline evaluation of these patients.
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229
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Kagan HJ, Belekdanian VD, Chen J, Backeris P, Hammoudi N, Turnbull IC, Costa KD, Hajjar RJ. Coronary capillary blood flow in a rat model of congestive heart failure. J Appl Physiol (1985) 2017; 124:632-640. [PMID: 29051335 DOI: 10.1152/japplphysiol.00741.2017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The aim of this study was to explore the role of abnormal coronary microvasculature morphology and hemodynamics in the development of congestive heart failure (CHF). CHF was induced in rats by aortic banding, followed by ischemia-reperfusion and later aortic debanding. Polymerized casts of coronary vasculature were imaged under a scanning electron microscope (SEM). Matrix Laboratory (MATLAB) software was used to calculate capillary structure index (CSI), a measure of structural alignment also called mean vector length (MVL), for 93 SEM images of coronary capillaries (CSI→1 perfect linearity; CSI→0 circular disarray). CSI was incorporated as a constant to represent tortuosity and nonlaminar flow in Poiseuille's equation to estimate the differences in capillary blood flow rate, velocity, and resistance for CHF vs. CONTROL The morphology of CHF capillaries is significantly disordered and tortuous compared with control (CSI: 0.35 ± 0.02 for 61 images from 7 CHF rats; 0.58 ± 0.02 for 32 images from 7 control rats; P < 0.01). Estimated capillary resistance in CHF is elevated by 173% relative to control, while blood flow rate and blood velocity are 56 and 43% slower than control. Capillary resistance increased 67% due to the significantly narrower capillary diameter in CHF, while it increased an additional 105% due to tortuosity. The significant structural abnormalities of CHF coronary capillaries may drastically stagnate hemodynamics in myocardium and increase resistance to blood flow. This could play a role in the development of CHF. NEW & NOTEWORTHY In the present study, coronary capillary tortuosity was measured by applying Matrix Laboratory software to scanning electron microscope images of capillaries in a rat model of congestive heart failure. Stagnant blood flow in coronary capillaries may play a role in the development of congestive heart failure. The application of computer modeling to histological and physiological data to characterize the hemodynamics of coronary microcirculation is a new area of study.
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Affiliation(s)
- Heather J Kagan
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Varujan D Belekdanian
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Jiqiu Chen
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Peter Backeris
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Nadjib Hammoudi
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Irene C Turnbull
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Kevin D Costa
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Roger J Hajjar
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai , New York, New York
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230
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Shamloo A, Nejad MA, Saeedi M. Fluid–structure interaction simulation of a cerebral aneurysm: Effects of endovascular coiling treatment and aneurysm wall thickening. J Mech Behav Biomed Mater 2017; 74:72-83. [DOI: 10.1016/j.jmbbm.2017.05.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 05/09/2017] [Accepted: 05/12/2017] [Indexed: 12/01/2022]
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231
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Chong DC, Yu Z, Brighton HE, Bear JE, Bautch VL. Tortuous Microvessels Contribute to Wound Healing via Sprouting Angiogenesis. Arterioscler Thromb Vasc Biol 2017; 37:1903-1912. [PMID: 28838921 PMCID: PMC5627535 DOI: 10.1161/atvbaha.117.309993] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 08/01/2017] [Indexed: 12/13/2022]
Abstract
Supplemental Digital Content is available in the text. Objective— Wound healing is accompanied by neoangiogenesis, and new vessels are thought to originate primarily from the microcirculation; however, how these vessels form and resolve during wound healing is poorly understood. Here, we investigated properties of the smallest capillaries during wound healing to determine their spatial organization and the kinetics of formation and resolution. Approach and Results— We used intravital imaging and high-resolution microscopy to identify a new type of vessel in wounds, called tortuous microvessels. Longitudinal studies showed that tortuous microvessels increased in frequency after injury, normalized as the wound healed, and were closely associated with the wound site. Tortuous microvessels had aberrant cell shapes, increased permeability, and distinct interactions with circulating microspheres, suggesting altered flow dynamics. Moreover, tortuous microvessels disproportionately contributed to wound angiogenesis by sprouting exuberantly and significantly more frequently than nearby normal capillaries. Conclusions— A new type of transient wound vessel, tortuous microvessels, sprout dynamically and disproportionately contribute to wound-healing neoangiogenesis, likely as a result of altered properties downstream of flow disturbances. These new findings suggest entry points for therapeutic intervention.
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Affiliation(s)
- Diana C Chong
- From the Curriculum in Genetics and Molecular Biology (D.C.C., Z.Y., V.L.B.), Department of Biology (V.L.B.), Lineberger Comprehensive Cancer Center (J.E.B., V.L.B.), McAllister Heart Institute (V.L.B.), and Department of Cell Biology and Physiology (H.E.B., J.E.B.), The University of North Carolina at Chapel Hill
| | - Zhixian Yu
- From the Curriculum in Genetics and Molecular Biology (D.C.C., Z.Y., V.L.B.), Department of Biology (V.L.B.), Lineberger Comprehensive Cancer Center (J.E.B., V.L.B.), McAllister Heart Institute (V.L.B.), and Department of Cell Biology and Physiology (H.E.B., J.E.B.), The University of North Carolina at Chapel Hill
| | - Hailey E Brighton
- From the Curriculum in Genetics and Molecular Biology (D.C.C., Z.Y., V.L.B.), Department of Biology (V.L.B.), Lineberger Comprehensive Cancer Center (J.E.B., V.L.B.), McAllister Heart Institute (V.L.B.), and Department of Cell Biology and Physiology (H.E.B., J.E.B.), The University of North Carolina at Chapel Hill
| | - James E Bear
- From the Curriculum in Genetics and Molecular Biology (D.C.C., Z.Y., V.L.B.), Department of Biology (V.L.B.), Lineberger Comprehensive Cancer Center (J.E.B., V.L.B.), McAllister Heart Institute (V.L.B.), and Department of Cell Biology and Physiology (H.E.B., J.E.B.), The University of North Carolina at Chapel Hill
| | - Victoria L Bautch
- From the Curriculum in Genetics and Molecular Biology (D.C.C., Z.Y., V.L.B.), Department of Biology (V.L.B.), Lineberger Comprehensive Cancer Center (J.E.B., V.L.B.), McAllister Heart Institute (V.L.B.), and Department of Cell Biology and Physiology (H.E.B., J.E.B.), The University of North Carolina at Chapel Hill.
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Oehler AC, Minnier J, Lindner JR. Increased Coronary Tortuosity Is Associated with Increased Left Ventricular Longitudinal Myocardial Shortening. J Am Soc Echocardiogr 2017; 30:1028-1034.e2. [PMID: 28781117 DOI: 10.1016/j.echo.2017.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND The mechanistic basis for tortuosity of the coronary arteries (TCA) is unclear. The aim of this study was to test the hypothesis that the relative degree of systolic longitudinal shortening of the left ventricle that deforms coaxially oriented coronary arteries is associated with TCA. METHODS Adult subjects undergoing coronary angiography and comprehensive echocardiography within 3 months were classified dichotomously as with (n = 32) or without (n = 42) TCA defined on the basis of number and severity of coronary angles. Systolic left ventricular (LV) longitudinal deformation was determined by mitral annular plane systolic excursion (MAPSE) from both B-mode displacement and tissue Doppler time-velocity integral; data were indexed to LV diastolic long-axis length. RESULTS There were no differences between groups with respect to age, gender, hypertension, or coronary artery disease. Patients with TCA had significantly (P < .01) lower LV mass index and a shorter total LV diastolic long-axis length (mean, 8.3 ± 1.9 vs 9.1 ± 2.2 cm; P < .01). Despite having a shorter length, those with TCA had greater MAPSE by both methods. MAPSE normalized to diastolic length was significantly greater (P < .01) in those with TCA, which remained the case after excluding subjects with reduced LV ejection fraction. Multiple linear regression found that lateral annular MAPSE had the largest effect size, with a 13-fold increase in likelihood for TCA for every 0.1 of normalized MAPSE. CONCLUSIONS TCA is not associated with increased LV mass but rather with smaller hearts that have greater relative longitudinal shortening of the left ventricle. This finding suggests that TCA could represent an adaptive response to longitudinal systolic distortion of coaxially oriented coronary arteries that dynamically produce shear stresses associated with expansive coronary remodeling.
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Affiliation(s)
- Andrew C Oehler
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Jessica Minnier
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Jonathan R Lindner
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon.
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Donepudi R, Mann LK, Wohlmuth C, Johnson A, Bebbington MW, Moise KJ, Boudreaux DS, Gardiner H, Papanna R. Recipient umbilical artery elongation (redundancy) in twin-twin transfusion syndrome. Am J Obstet Gynecol 2017; 217:206.e1-206.e11. [PMID: 28455084 DOI: 10.1016/j.ajog.2017.04.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 04/04/2017] [Accepted: 04/14/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Chronic hypertension in adults causes arterial lengthening in major arteries, but the effects of early fetal hypertension on the twin-twin transfusion syndrome recipient's vascular architecture remains unknown. OBJECTIVE We hypothesize that arterial cord redundancy is related to recipient hypertension and subsequent heart failure. Our objectives were to: (1) establish a 3-dimensional color Doppler ultrasound method of measuring umbilical arterial length relative to its corresponding venous segment in the umbilical cord using artery vein angle; (2) compare recipient artery vein angle to gestational age-matched controls; and (3) test the association of artery vein angle with recipient heart failure. STUDY DESIGN We compared 3 groups prospectively: twin-twin transfusion syndrome pregnancies undergoing fetoscopic laser surgery (preoperatively) and 2 groups of gestational age-matched controls: uncomplicated monochorionic-diamniotic twin pregnancies and healthy singletons. Using a 3-dimensional color-Doppler volume image of 5 cm of cord near the placental insertion, we traced the umbilical artery and vein producing umbilical artery:vein length, (artery vein index) and measured the artery vein angle between umbilical artery and vein. Correlation of artery vein angle to twin-twin transfusion syndrome stage, maximum vertical pocket, umbilical arterial indices, ductus venosus Doppler, and brain natriuretic peptide were performed. We used pulsed-wave and tissue Doppler to measure tissue Doppler velocities and indexed cardiac output and correlated these with artery vein angle. Comparative statistics, including multivariable linear regression, examined the relationship between umbilical arterial Doppler indices and artery vein angle. RESULTS Artery vein angle and artery vein index correlated significantly (R2, 0.86; P < .0001), hence, artery vein angle was used for analysis. Mean artery vein angle was 33.1 ± 31.5 degrees in recipients (n = 44), 9.5 ± 6 degrees in monochorionic-diamniotic (n = 11; 22 fetuses), and 8.9 ± 8.3 degrees in singleton controls (n = 16) (P < .001). An artery vein angle ≥26 degrees (>95th percentile for controls) was measured in 52% recipients. Artery vein angle was higher in twin-twin transfusion syndrome stage 3R vs 1 (P = .001). Artery vein angle increased with increasing umbilical arterial pulsatility index (P < .001), and decreased with increasing resistance index (P = .02) after adjusting for gestational age. Interrater agreements to categorize abnormal artery vein angle values was 95% (P < .001). Abnormal ductus venosus Doppler and elevated recipient amniotic fluid N-terminal pro-brain natriuretic peptide/protein levels correlated significantly with artery vein angle. Abnormal artery vein angles were associated with decreased indexed cardiac output, lower tissue Doppler velocities, higher right-sided Tei indices, and severe tricuspid regurgitation. CONCLUSION Umbilical arterial lengthening occurs in 52% of recipients and is associated with abnormal Doppler flows, low systolic tissue Doppler velocities, reduced cardiac output, and elevated markers of cardiac failure. This may reflect chronicity and severity of hypertension in the recipient fetus. Further research is needed to explore the mechanisms of elongation and long-term implications.
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234
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van Twist DJL, de Leeuw PW, Kroon AA. Coronary Tortuosity: A Clue to the Diagnosis of Fibromuscular Dysplasia? Am J Hypertens 2017; 30:776-780. [PMID: 28472222 DOI: 10.1093/ajh/hpx069] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 03/30/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Fibromuscular dysplasia (FMD) is a systemic, nonatherosclerotic, noninflammatory vasculopathy that is often overlooked by clinicians. Clinical clues could help in selecting patients for further evaluation for the presence of FMD. Recently, it was observed that tortuosity of the coronary arteries is often present in patients with FMD-related abnormalities of the coronary artery. Therefore, we wondered if the presence of coronary tortuosity might provide a clinical clue to the diagnosis of extracoronary FMD. CASES We describe 5 cases of FMD in whom diagnostic studies for FMD were initiated because of the presence of coronary tortuosity. FMD was found in all 5 patients in the renal and/or cervical arteries. CONCLUSIONS Our 5 cases suggest that exertional chest pain in the presence of coronary tortuosity may be helpful in selecting patients for further evaluation for the presence of FMD. Further research should focus on the prevalence of FMD among patients with coronary tortuosity and whether the presence of additional clinical clues (such as the presence of hypertension at young age or pulsatile tinnitus) next to coronary tortuosity can predict the risk for FMD in individual patients.
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Affiliation(s)
- Daan J L van Twist
- Department of Internal Medicine and CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Peter W de Leeuw
- Department of Internal Medicine and CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
- Department of Internal Medicine, Zuyderland Medical Centre, Sittard, The Netherlands
| | - Abraham A Kroon
- Department of Internal Medicine and CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
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235
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Katsanos S, Katogiannis K, Parissis J. Syncope in a patient with tortuous right common carotid artery. Hippokratia 2017; 21:160. [PMID: 30479483 PMCID: PMC6248001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- S Katsanos
- Department of Emergency Medicine, "Attikon" University Hospital, Athens, Greece
| | - K Katogiannis
- Department of Emergency Medicine, "Attikon" University Hospital, Athens, Greece
| | - J Parissis
- Department of Emergency Medicine, "Attikon" University Hospital, Athens, Greece
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236
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Takata M, Fukuda H, Kinosada M, Miyake K, Murao K. Use of Simple Neck Extension to Improve Guiding Catheter Accessibility in Tortuous Cervical Internal Carotid Artery for Endovascular Embolization of Intracranial Aneurysm: A Technical Note. World Neurosurg 2017; 105:529-533. [PMID: 28619490 DOI: 10.1016/j.wneu.2017.06.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 06/01/2017] [Accepted: 06/02/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND In endovascular embolization of intracranial aneurysms, a tortuous cervical internal carotid artery can limit guiding catheter access to a sufficiently high position. Although intermediate distal access catheters can go beyond the tortuous segment of internal carotid arteries, they may increase the risk of procedure-related complications, require significantly complex technical procedures, and limit the use of adjunctive techniques. Using simple neck extension alone, we successfully improved guiding catheter access in 2 patients. METHODS Through a provocative test, we confirmed suitability of manual neck extension in 2 patients with severe posterior curvature of a tortuous internal carotid artery. Intraoperatively, we manually extended the neck and stretched the curvatures. We guided a 6F guiding catheter superiorly and performed coil embolization with an occlusion balloon catheter in 1 case and with the balloon-assisted neck remodeling technique in 1 case. RESULTS Coil embolization was completed without any adverse events in both cases. CONCLUSIONS The simple neck extension technique successfully improved accessibility of the guiding catheter. As the need for safe and highly skilled intervention increases, our technique may be useful because it can reduce procedure-related complications and allow balloon-assisted techniques.
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Affiliation(s)
- Megumu Takata
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Okayama, Japan.
| | - Hitoshi Fukuda
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Masanori Kinosada
- Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Kosuke Miyake
- Department of Neuroendovascular Therapy, Shiroyama Hospital, Habikino, Osaka, Japan
| | - Kenichi Murao
- Department of Neuroendovascular Therapy, Shiroyama Hospital, Habikino, Osaka, Japan
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Tanyildizi Y, Gökce S, Marini F, Mayer AK, Kirschner S, Hennermann JB, Brockmann MA. Vessel shape alterations of the vertebrobasilar arteries in Mucopolysaccharidosis type IVa (Morquio A) patients. Eur J Radiol 2017; 93:128-133. [PMID: 28668406 DOI: 10.1016/j.ejrad.2017.05.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Accepted: 05/21/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Main symptom of mucopolysaccharidosis type IVa (MPS IVa) is progressive systemic skeletal dysplasia. This is routinely monitored by cerebral and spinal MRI. The vascular system is generally not in the primary focus of interest. In our population of MPS IVa patients we observed vessel shape alterations of the vertebrobasilar arteries, which has not been described before. MATERIAL AND METHODS MRI-datasets of 26 patients with MPS IVa acquired between 2008 and 2015 were eligible for retrospective analysis of the vertebrobasilar arteries. The vessel length and angle of the basilar artery (BA) and both vertebral arteries (VA) were analyzed. A deflection angle between 90° and 130° in the vessel course was defined as tortuosity, less than 90° as kinking. The results were compared to a matched control group of 23 patients not suffering from MPS. RESULTS The deflection angle [°] of the VA and BA was significantly decreased in the majority (85%) of MPS IVa patients compared to the control group: BA 132±24 vs. 177±6, BA/VA transition 113±21 vs. 152±13, right VA 108±23 vs. 156±13, left VA 110± 22 vs. 157±14 (all p<0.005). Likewise, vessels of MPS IVa patients were significantly longer compared to the control group: BA 27±4 vs. 21±2, right VA 20±6 vs. 10±1, left VA 18±5 vs. 11±2 (all p<0.005). CONCLUSION MPS IVa is associated with significantly increased tortuosity of vertebrobasilar arteries. Therefore the vascular system of MPS IVa patients should be monitored on routinely basis, as vessel shape alterations had been associated with dissections, leading to a higher risk of cerebrovascular events.
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Affiliation(s)
- Yasemin Tanyildizi
- Department of Neuroradiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.
| | - Seyfullah Gökce
- Department of Pediatric and Adolescent Medicine, Villa Metabolica, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Federico Marini
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Anna K Mayer
- Department of Neuroradiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Stefanie Kirschner
- Department of Neuroradiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Julia B Hennermann
- Department of Pediatric and Adolescent Medicine, Villa Metabolica, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Marc A Brockmann
- Department of Neuroradiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
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238
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Koh W, Kallenberg K, Karch A, Frank T, Knauth M, Bähr M, Liman J. Transcranial doppler sonography is not a valid diagnostic tool for detection of basilar artery stenosis or in-stent restenosis: a retrospective diagnostic study. BMC Neurol 2017; 17:89. [PMID: 28490351 PMCID: PMC5426050 DOI: 10.1186/s12883-017-0872-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 05/06/2017] [Indexed: 11/26/2022] Open
Abstract
Background There are contradictory reports concerning the validity of transcranial sonography (TCD and TCCS) for examinations of the basilar artery. Here we investigated sensitivity and specificity of transcranial sonography for the detection of basilar artery stenosis and in-stent-restenosis compared to cerebral angiography. Methods We analyzed data of 104 examinations of the basilar artery. The association between sonographic peak systolic velocity (PSV) and degree of stenosis obtained by cerebral angiography was evaluated applying Spearman’s correlation coefficient. Receiver Operating Characteristics (ROC) curves and areas under the curve (AUC) were calculated for the detection of a ≥50% stenosis defined by angiography. Optimal cut-off was derived using the Youden-index. Results A weak but statistically significant correlation between PSV and the degree of stenosis was found (n=104, rho=0.35, p<0.001). ROC analysis for a detection of ≥50% stenosis showed an AUC of 0.70, a sensitivity of 74.0% and a specificity of 65.0% at the optimal cut off of 124 cm/s. Results were consistent when analyzing examinations done in stented and unstented arteries separately (TCD VS DSA/CTA in unstented artery: AUC=0.66, sensitivity 61.0%, specificity 65.0%, TCD/TCCS VS DSA in stented artery: AUC=0.63, sensitivity 71.0%, specificity 82.0%). Comparing TCCS measurements exclusively to angiography, ROC analysis showed an AUC of 1.00 for the detection of an in-stent-restenosis ≥50% with a sensitivity and specificity of 100% when a PSV of 132 cm/s was used as a cut off value. Conclusion Validity of TCD in the assessment of basilar artery stenosis or in-stent restenosis is poor. First results for TCCS are promising, but due to the small samplesize further studies with larger samples sizes are warranted.
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Affiliation(s)
- Woori Koh
- Department of Neurology, University of Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
| | - Kai Kallenberg
- Department of Neuroradiology, University of Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
| | - André Karch
- Epidemiological and Statistical Methods, Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstr. 7, 38124, Braunschweig, Germany
| | - Tobias Frank
- Department of Neurology, University of Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
| | - Michael Knauth
- Department of Neuroradiology, University of Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
| | - Mathias Bähr
- Department of Neurology, University of Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
| | - Jan Liman
- Department of Neurology, University of Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany.
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Garcia JR, Sanyal A, Fatemifar F, Mottahedi M, Han HC. Twist buckling of veins under torsional loading. J Biomech 2017; 58:123-130. [PMID: 28526174 DOI: 10.1016/j.jbiomech.2017.04.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 03/31/2017] [Accepted: 04/24/2017] [Indexed: 10/19/2022]
Abstract
Veins are often subjected to torsion and twisted veins can hinder and disrupt normal blood flow but their mechanical behavior under torsion is poorly understood. The objective of this study was to investigate the twist deformation and buckling behavior of veins under torsion. Twist buckling tests were performed on porcine internal jugular veins (IJVs) and human great saphenous veins (GSVs) at various axial stretch ratio and lumen pressure conditions to determine their critical buckling torques and critical buckling twist angles. The mechanical behavior under torsion was characterized using a two-fiber strain energy density function and the buckling behavior was then simulated using finite element analysis. Our results demonstrated that twist buckling occurred in all veins under excessive torque characterized by a sudden kink formation. The critical buckling torque increased significantly with increasing lumen pressure for both porcine IJV and human GSV. But lumen pressure and axial stretch had little effect on the critical twist angle. The human GSVs are stiffer than the porcine IJVs. Finite element simulations captured the buckling behavior for individual veins under simultaneous extension, inflation, and torsion with strong correlation between predicted critical buckling torques and experimental data (R2=0.96). We conclude that veins can buckle under torsion loading and the lumen pressure significantly affects the critical buckling torque. These results improve our understanding of vein twist behavior and help identify key factors associated in the formation of twisted veins.
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Affiliation(s)
- Justin R Garcia
- Department of Mechanical Engineering, University of Texas at San Antonio, USA; Biomedical Engineering Program, UTSA-UTHSCSA, USA
| | - Arnav Sanyal
- Department of Mechanical Engineering, University of Texas at San Antonio, USA
| | - Fatemeh Fatemifar
- Department of Mechanical Engineering, University of Texas at San Antonio, USA
| | - Mohammad Mottahedi
- Department of Mechanical Engineering, University of Texas at San Antonio, USA
| | - Hai-Chao Han
- Department of Mechanical Engineering, University of Texas at San Antonio, USA; Biomedical Engineering Program, UTSA-UTHSCSA, USA; Institute of Mechanobiology & Medical Engineering, Shanghai Jiaotong University, China.
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240
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Cerit L, Cerit Z. Relationship between coronary tortuosity and plateletcrit coronary tortuosity and plateletcrit. Cardiovasc J Afr 2017; 28:385-388. [PMID: 28470327 PMCID: PMC5885048 DOI: 10.5830/cvja-2017-023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 04/11/2017] [Indexed: 12/20/2022] Open
Abstract
Background Coronary tortuosity (CorT) is a common angiographic finding and may be associated with myocardial ischaemia, even without coronary artery disease. Platelets play a crucial role in inflammatory and thrombotic processes and the physiopathology of cardiovascular disease. Larger platelets are more active enzymatically and have higher thrombotic ability compared to smaller platelets. Plateletcrit (PCT) provides complete information on total platelet mass. We aimed to evaluate the relationship between CorT and PCT in patients with chronic stable angina. Methods The medical records of consecutive patients who underwent coronary angiography from January 2013 to January 2016 were retrospectively reviewed for CorT. CorT and clinical, echocardiographic, haematological and biochemical parameters were evaluated. Taking into consideration the inclusion criteria, 106 patients with CorT and 108 with normal coronary angiographies (control group) were included in the study. CorT was defined as three fixed bends during both systole and diastole, with each bend ≥ 45°. Results The median PCT, mean platelet volume (MPV), platelet:large-cell ratio (P-LCR), neutrophil:lymphocyte ratio (NLR) and platelet:lymphocyte ratio (PLR) of the CorT group were significantly higher than those of the control group (0.26 ± 0.02 vs 0.2 ± 0.03%, p < 0.001; 10.6 ± 0.14 vs 9.6 ± 0.65 fl, p < 0.001; 29.3 ± 6.7 vs 23.4 ± 5.1, p < 0.001; 2.3 ± 1 vs 1.47 ± 0.48, p < 0.001; 1.28 ± 0.5 vs 0.82 ± 0.23, p < 0.001, respectively). The incidence of diabetes mellitus, hypertension and female gender were significantly higher in the CorT group (18.9 vs 1.9%, p < 0.001, 90.6 vs 50%, p < 0.001, 70.8 vs 44.4%, p < 0.001, respectively). Multivariate logistic regression analysis revealed age, hypertension, diabetes mellitus and plateletcrit were independently associated with CorT. Conclusion CorT was associated with increased PCT, MPV, P-LCR, NLR and PLR, even in the absence of coronary artery disease. Age, hypertension, diabetes mellitus and plateletcrit were independently associated with CorT.
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241
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Grinband J, Steffener J, Razlighi QR, Stern Y. BOLD neurovascular coupling does not change significantly with normal aging. Hum Brain Mapp 2017; 38:3538-3551. [PMID: 28419680 DOI: 10.1002/hbm.23608] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 03/28/2017] [Accepted: 03/28/2017] [Indexed: 12/11/2022] Open
Abstract
Studies of cognitive function that compare the blood oxygenation level dependent (BOLD) signal across age groups often require the assumption that neurovascular coupling does not change with age. Tests of this assumption have produced mixed results regarding the strength of the coupling and its relative time course. Using deconvolution, we found that age does not have a significant effect on the time course of the hemodynamic impulse response function or on the slope of the BOLD versus stimulus duration relationship. These results suggest that in cognitive studies of healthy aging, group differences in BOLD activation are likely due to age-related changes in cognitive-neural interactions and information processing rather than to impairments in neurovascular coupling. Hum Brain Mapp 38:3538-3551, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Jack Grinband
- Department of Radiology, Columbia University, New York
| | - Jason Steffener
- Interdisciplinary School of Health Sciences, University of Ottawa, Ontario
| | - Qolamreza R Razlighi
- Department of Neurology, Columbia University, New York.,Department of Biomedical Engineering, Columbia University, New York
| | - Yaakov Stern
- Department of Neurology, Columbia University, New York
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Abstract
The incidence of vertigo in the population is 20% to 30% and one-fourth of the cases are related to central causes. The aim of this study was to evaluate computed tomography angiography (CTA) findings of the vertebrobasilar system in central vertigo without stroke.CTA and magnetic resonance images of patients with vertigo were retrospectively evaluated. One hundred twenty-nine patients suspected of having central vertigo according to history, physical examination, and otological and neurological tests without signs of infarction on diffusion-weighted magnetic resonance imaging were included in the study. The control group included 120 patients with similar vascular disease risk factors but without vertigo. Vertebral and basilar artery diameters, hypoplasias, exit-site variations of vertebral artery, vertebrobasilar tortuosity, and stenosis of ≥50% detected on CTA were recorded for all patients. Independent-samples t test was used in variables with normal distribution, and Mann-Whitney U test in non-normal distribution. The difference of categorical variable distribution according to groups was analyzed with χ and/or Fisher exact test.Vertebral artery hypoplasia and ≥50% stenosis were seen more often in the vertigo group (P = 0.000, <0.001). Overall 78 (60.5%) vertigo patients had ≥50% stenosis, 54 (69.2%) had stenosis at V1 segment, 9 (11.5%) at V2 segment, 2 (2.5%) at V3 segment, and 13 (16.6%) at V4 segment. Both vertigo and control groups had similar basilar artery hypoplasia and ≥50% stenosis rates (P = 0.800, >0.05).CTA may be helpful to clarify the association between abnormal CTA findings of vertebral arteries and central vertigo.This article reveals the opportunity to diagnose posterior circulation abnormalities causing central vertigo with a feasible method such as CTA.
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243
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Retinal microvascular plasticity in a premature neonate. J Dev Orig Health Dis 2017; 8:284-286. [PMID: 28137344 DOI: 10.1017/s2040174416000817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Dilation and abnormal tortuosity of retinal vessels are the hallmarks of severe retinopathy of prematurity (ROP) in premature infants. The stages of ROP are defined by vessel appearance at the interface between the vascular and avascular retinal areas. Deregulated signaling pathways involving hypoxia-inducible factors such as vascular endothelial growth factor (VEGF) are involved in the pathogenesis of ROP. VEGF-antagonists are increasingly being used as 'off-label medication' to treat this condition, with some success. We present Baby SM (female), who was born prematurely at 24 weeks gestation in a tertiary neonatal intensive care unit, and with a birth weight of 640 g. On screening at 35 weeks postmenstrual age (PMA), she was noted to have ROP, which became severe by 37 weeks PMA. She received one dose of intravitreal VEGF antagonist (Bevacizumab), resulting in a decrease in vessel tortuosity and dilation. However, repeat imaging at 4 weeks showed a re-emergence of vessel tortuosity. We believe the observed changes demonstrate an inherent retinal microvascular plasticity in premature neonates. With improved survival of extremely premature neonates and the availability of retinal imaging technology, we are now able to observe this plasticity.
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244
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Letter to the Editor. Cardiovasc J Afr 2017. [PMCID: PMC5885044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] Open
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245
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Feng ZG, Cortina M, Chesnutt JKW, Han HC. Numerical Simulation of Thrombotic Occlusion in Tortuous Arterioles. JOURNAL OF CARDIOLOGY AND CARDIOVASCULAR MEDICINE 2017; 2:95-111. [PMID: 29327739 PMCID: PMC5760268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Tortuous microvessels alter blood flow and stimulate thrombosis but the physical mechanisms are poorly understood. Both tortuous microvessels and abnormally large platelets are seen in diabetic patients. Thus, the objective of this study was to determine the physical effects of arteriole tortuosity and platelet size on the microscale processes of thrombotic occlusion in microvessels. A new lattice-Boltzmann method-based discrete element model was developed to simulate the fluid flow field with fluid-platelet coupling, platelet interactions, thrombus formation, and thrombotic occlusion in tortuous arterioles. Our results show that vessel tortuosity creates high shear stress zones that activate platelets and stimulate thrombus formation. The growth rate depends on the level of tortuosity and the pressure and flow boundary conditions. Once thrombi began to form, platelet collisions with thrombi and subsequent activations were more important than tortuosity level. Thrombus growth narrowed the channel and reduced the flow rate. Larger platelet size leads to quicker decrease of flow rate due to larger thrombi that occluded the arteriole. This study elucidated the important roles that tortuosity and platelet size play in thrombus formation and occlusion in arterioles.
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Affiliation(s)
- Zhi-Gang Feng
- Department of Mechanical Engineering, USA,Address for Correspondence: Dr. Hai-Chao Han, Department of Mechanical Engineering, The University of Texas at San Antonio, San Antonio, TX 78249, Texas, USA, Tel: (210) 458-4952; Fax: (210) 458-6504; . Dr. Zhi-Gang Feng, Department of Mechanical Engineering, The University of Texas at San Antonio, San Antonio, TX 78249, Texas, USA, Tel: (210) 458-4952; Fax: (210) 458-6504;
| | | | | | - Hai-Chao Han
- Department of Mechanical Engineering, USA,Biomedical Engineering Program, UTSA-UTHSCSA, USA,Address for Correspondence: Dr. Hai-Chao Han, Department of Mechanical Engineering, The University of Texas at San Antonio, San Antonio, TX 78249, Texas, USA, Tel: (210) 458-4952; Fax: (210) 458-6504; . Dr. Zhi-Gang Feng, Department of Mechanical Engineering, The University of Texas at San Antonio, San Antonio, TX 78249, Texas, USA, Tel: (210) 458-4952; Fax: (210) 458-6504;
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Tortuous Carotid Artery Extended to Neck Level IIb Mimicking the Metastatic Mass. Case Rep Otolaryngol 2016; 2016:1376926. [PMID: 27891275 PMCID: PMC5116511 DOI: 10.1155/2016/1376926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 10/17/2016] [Accepted: 10/31/2016] [Indexed: 11/17/2022] Open
Abstract
Specifically in neck level IIb, the expected normal anatomy does not contain any vital structures and consequently it might direct a surgeon to perform rapid surgical dissection of tissues. Therefore aberrant anatomy of the vessels in the patients may be overlooked during neck dissection. Unexpected and potentially devastating injuries can be avoided by respecting the possible aberrant anatomy in any level of the neck. In this case report, a 74-year-old man was presented with laryngeal carcinoma who was treated with laryngectomy and bilateral neck dissection. During the left side neck dissection, tortuous internal carotid artery imitating a metastatic mass was unexpectedly encountered in level IIb. As in this case, surgeons should keep in mind possible aberrant anatomy during the neck dissection and perform surgery staying in surgical principles to be safe for an unforeseen and potential dangerous injuries.
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247
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Colombi M, Dordoni C, Venturini M, Zanca A, Calzavara-Pinton P, Ritelli M. Delineation of Ehlers-Danlos syndrome phenotype due to the c.934C>T, p.(Arg312Cys) mutation in COL1A1: Report on a three-generation family without cardiovascular events, and literature review. Am J Med Genet A 2016; 173:524-530. [PMID: 28102596 DOI: 10.1002/ajmg.a.38035] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 10/10/2016] [Indexed: 01/12/2023]
Abstract
Classical Ehlers-Danlos syndrome (cEDS) is a rare connective tissue disorder primarily characterized by hyperextensible skin, defective wound healing, abnormal scars, easy bruising, and generalized joint hypermobility; arterial dissections are rarely observed. Mutations in COL5A1 and COL5A2 encoding type V collagen account for more than 90% of the patients so far characterized. In addition, cEDS phenotype was reported in a small number of patients carrying the c.934C>T mutation in COL1A1 that results in an uncommon substitution of a non-glycine residue in one Gly-Xaa-Yaa repeat of the pro-α1(I)-chain p.(Arg312Cys), which leads to disturbed collagen fibrillogenesis due to delayed removal of the type I procollagen N-propeptide. This specific mutation has been associated with propensity to arterial rupture in early adulthood; indeed, in literature the individuals harboring this mutation are also referred to as "(classic) vascular-like" EDS patients. Herein, we describe a three-generation cEDS family with six adults carrying the p.(Arg312Cys) substitution, which show a variable and prevalent cutaneous involvement without any major vascular event. These data, together with those available in literature, suggest that vascular events are not a diagnostic handle to differentiate patients with the p.(Arg312Cys) COL1A1 mutation from those with COL5A1 and COL5A2 defects, and highlight that during the diagnostic process the presence of at least the p.(Arg312Cys) substitution in COL1A1 should be investigated in cEDS patients without type V collagen mutations. Nevertheless, for these patients, as well as for those affected with cEDS, a periodical vascular surveillance should be carried out together with cardiovascular risk factors monitoring. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Marina Colombi
- Department of Molecular and Translational Medicine, School of Medicine, Division of Biology and Genetics, University of Brescia, Brescia, Italy
| | - Chiara Dordoni
- Department of Molecular and Translational Medicine, School of Medicine, Division of Biology and Genetics, University of Brescia, Brescia, Italy
| | - Marina Venturini
- Department of Clinical and Experimental Sciences, Division of Dermatology, Spedali Civili University Hospital, Berscia, Italy
| | - Arianna Zanca
- Department of Clinical and Experimental Sciences, Division of Dermatology, Spedali Civili University Hospital, Berscia, Italy
| | - Piergiacomo Calzavara-Pinton
- Department of Clinical and Experimental Sciences, Division of Dermatology, Spedali Civili University Hospital, Berscia, Italy
| | - Marco Ritelli
- Department of Molecular and Translational Medicine, School of Medicine, Division of Biology and Genetics, University of Brescia, Brescia, Italy
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Kim BJ, Yang E, Kim NY, Kim MJ, Kang DW, Kwon SU, Kim JS. Vascular Tortuosity May Be Associated With Cervical Artery Dissection. Stroke 2016; 47:2548-52. [PMID: 27531344 DOI: 10.1161/strokeaha.116.013736] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 07/18/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Dissection is an increasingly recognized cause of ischemic stroke, which occurs spontaneously or after trauma, in relatively young patients. We hypothesized that there might be a predisposing factor weakening the vascular wall and that arterial tortuosity might be higher in patients with dissection. METHODS We consecutively enrolled cervical artery dissection (CerAD) patients who had undergone magnetic resonance angiography. Age- and sex-matched healthy subjects who underwent magnetic resonance angiography in a routine health examination were used as controls. The tortuosity was measured semiautomatically from the carotid artery and vertebral artery (VA) arteries. Tortuosity index was defined as: [(arc/chord)-1×100] in each arteries. Independent risk factors associated with CerAD were investigated using multivariable analysis. Subgroup analysis according to the dissected artery was performed. RESULTS There were no differences in vascular risk factors between the 75 CerAD patients and the 75 controls. The tortuosity indexes of the contralesional VA (16.3±6.8 versus 12.1±4.5, respectively; P<0.001) and carotid artery (8.8±4.0 versus 7.3±2.9, respectively; P=0.01) were higher in patients with CerAD compared with those of control subjects. VA tortuosity (odds ratio, 1.175; P=0.001) was independently associated with the presence of CerAD. In subgroup analysis, VA tortuosity was significantly higher in 57 patients with VA dissection than in controls (P<0.001), and carotid artery tortuosity was marginally higher in 18 patients with carotid artery dissection (P=0.05). CONCLUSIONS CerAD is associated with tortuous cervical arteries, which may implicate weakened cervical vascular structure in these patients.
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Affiliation(s)
- Bum Joon Kim
- From the Department of Neurology, Kyung Hee University Hospital, Kyung Hee University, College of Medicine, Seoul, Korea (B.J.K.); Department of Neurology, University of Ulsan (B.J.K., N.-Y.K., D.-W.K., S.U.K., J.S.K.), Health Screening and Promotion Center (M.-J.K.), and Asan Institute of Life Science (E.Y.), Asan Medical Center, Seoul, Korea
| | - Ewha Yang
- From the Department of Neurology, Kyung Hee University Hospital, Kyung Hee University, College of Medicine, Seoul, Korea (B.J.K.); Department of Neurology, University of Ulsan (B.J.K., N.-Y.K., D.-W.K., S.U.K., J.S.K.), Health Screening and Promotion Center (M.-J.K.), and Asan Institute of Life Science (E.Y.), Asan Medical Center, Seoul, Korea
| | - Na-Young Kim
- From the Department of Neurology, Kyung Hee University Hospital, Kyung Hee University, College of Medicine, Seoul, Korea (B.J.K.); Department of Neurology, University of Ulsan (B.J.K., N.-Y.K., D.-W.K., S.U.K., J.S.K.), Health Screening and Promotion Center (M.-J.K.), and Asan Institute of Life Science (E.Y.), Asan Medical Center, Seoul, Korea
| | - Mi-Jung Kim
- From the Department of Neurology, Kyung Hee University Hospital, Kyung Hee University, College of Medicine, Seoul, Korea (B.J.K.); Department of Neurology, University of Ulsan (B.J.K., N.-Y.K., D.-W.K., S.U.K., J.S.K.), Health Screening and Promotion Center (M.-J.K.), and Asan Institute of Life Science (E.Y.), Asan Medical Center, Seoul, Korea
| | - Dong-Wha Kang
- From the Department of Neurology, Kyung Hee University Hospital, Kyung Hee University, College of Medicine, Seoul, Korea (B.J.K.); Department of Neurology, University of Ulsan (B.J.K., N.-Y.K., D.-W.K., S.U.K., J.S.K.), Health Screening and Promotion Center (M.-J.K.), and Asan Institute of Life Science (E.Y.), Asan Medical Center, Seoul, Korea
| | - Sun U Kwon
- From the Department of Neurology, Kyung Hee University Hospital, Kyung Hee University, College of Medicine, Seoul, Korea (B.J.K.); Department of Neurology, University of Ulsan (B.J.K., N.-Y.K., D.-W.K., S.U.K., J.S.K.), Health Screening and Promotion Center (M.-J.K.), and Asan Institute of Life Science (E.Y.), Asan Medical Center, Seoul, Korea
| | - Jong S Kim
- From the Department of Neurology, Kyung Hee University Hospital, Kyung Hee University, College of Medicine, Seoul, Korea (B.J.K.); Department of Neurology, University of Ulsan (B.J.K., N.-Y.K., D.-W.K., S.U.K., J.S.K.), Health Screening and Promotion Center (M.-J.K.), and Asan Institute of Life Science (E.Y.), Asan Medical Center, Seoul, Korea.
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249
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Han HC, Liu Q, Jiang ZL. Mechanical behavior and wall remodeling of blood vessels under axial twist. YI YONG SHENG WU LI XUE 2016; 31:319-326. [PMID: 28529430 PMCID: PMC5437748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Blood vessels are often subjected to axial torsion (or twist) due to body movement or surgery. However, there are few studies on blood vessel under twist. This review first summarizes the clinical observation on the twist of blood vessels and then presents what we know about the mechanical behaviors of blood vessel under twist, including the constitutive models. The state of art researches on the remodeling of blood vessels under twist via ex vivo organ culture, in vivo animal experiments, and mathematical model simulations are further discussed. It is our hope that this review will draw attention for further in-depth studies on the behavior and remodeling of blood vessels under twist.
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Affiliation(s)
- Hai-Chao Han
- Department of Mechanical Engineering, University of Texas at San Antonio, San Antonio, TX 78249, USA
- Institute of Mechanobiology & Medical Engineering, School of Life Sciences & Biotechnology, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Qin Liu
- Department of Mechanical Engineering, University of Texas at San Antonio, San Antonio, TX 78249, USA
| | - Zong-Lai Jiang
- Institute of Mechanobiology & Medical Engineering, School of Life Sciences & Biotechnology, Shanghai Jiao Tong University, Shanghai 200240, China
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250
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Rahaghi FN, Ross JC, Agarwal M, González G, Come CE, Diaz AA, Vegas-Sánchez-Ferrero G, Hunsaker A, San José Estépar R, Waxman AB, Washko GR. Pulmonary vascular morphology as an imaging biomarker in chronic thromboembolic pulmonary hypertension. Pulm Circ 2016; 6:70-81. [PMID: 27162616 PMCID: PMC4860553 DOI: 10.1086/685081] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Patients with chronic thromboembolic pulmonary hypertension (CTEPH) have morphologic changes to the pulmonary vasculature. These include pruning of the distal vessels, dilation of the proximal vessels, and increased vascular tortuosity. Advances in image processing and computer vision enable objective detection and quantification of these processes in clinically acquired computed tomographic (CT) scans. Three-dimensional reconstructions of the pulmonary vasculature were created from the CT angiograms of 18 patients with CTEPH diagnosed using imaging and hemodynamics as well as 15 control patients referred to our Dyspnea Clinic and found to have no evidence of pulmonary vascular disease. Compared to controls, CTEPH patients exhibited greater pruning of the distal vasculature (median density of small-vessel volume: 2.7 [interquartile range (IQR): 2.5-3.0] vs. 3.2 [3.0-3.8]; P = 0.008), greater dilation of proximal arteries (median fraction of blood in large arteries: 0.35 [IQR: 0.30-0.41] vs. 0.23 [0.21-0.31]; P = 0.0005), and increased tortuosity in the pulmonary arterial tree (median: 4.92% [IQR: 4.85%-5.21%] vs. 4.63% [4.39%-4.92%]; P = 0.004). CTEPH was not associated with dilation of proximal veins or increased tortuosity in the venous system. Distal pruning of the vasculature was correlated with the cardiac index (R = 0.51, P = 0.04). Quantitative models derived from CT scans can be used to measure changes in vascular morphology previously described subjectively in CTEPH. These measurements are also correlated with invasive metrics of pulmonary hemodynamics, suggesting that they may be used to assess disease severity. Further work in a larger cohort may enable the use of such measures as a biomarker for diagnostic, phenotyping, and prognostic purposes.
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Affiliation(s)
- F N Rahaghi
- Pulmonary and Critical Care Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - J C Ross
- Department of Radiology, Harvard School of Medicine, Boston, Massachusetts, USA
| | - M Agarwal
- Pulmonary and Critical Care Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - G González
- Department of Radiology, Harvard School of Medicine, Boston, Massachusetts, USA
| | - C E Come
- Pulmonary and Critical Care Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - A A Diaz
- Pulmonary and Critical Care Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - A Hunsaker
- Department of Radiology, Harvard School of Medicine, Boston, Massachusetts, USA
| | - R San José Estépar
- Department of Radiology, Harvard School of Medicine, Boston, Massachusetts, USA
| | - A B Waxman
- Pulmonary and Critical Care Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - G R Washko
- Pulmonary and Critical Care Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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