Systematic Review of Morphometric Analysis of Anterior Cerebral Artery (ACA) Emphasizing on Its Clinical Implications

Thorough data of morphometric measurements of arteries forming Circle of Willis (CW) is crucial for radiological and neurosurgical interventions. This systematic review has been conducted with the objective to find an effective range of length and diameter of anterior cerebral artery (ACA) and to observe whether there is any change in the length and diameter of ACA depending on age or sex. Articles based on length and diameter of ACA via any mode of study like cadaveric or radiological were considered in this systematic review. A comprehensive literature search using databases Cochrane Library, PubMed, and Scopus for relevant articles was done. Research papers which answered the focused questions were selected for data analysis. It was observed that the range of length and diameter of ACA were 8.1 mm-21 mm and 0.5 Å-3.4 mm, respectively. In majority of the studies, length and diameter of ACA were more in the younger age group (>40 years); and the length of ACA was more in females whereas the diameter of ACA was more in males. These data will be applicable for better construction and decipherment of angiographic images. This will help in the proper and guided treatment of intracranial pathologies.

Only transesophageal echocardiography guided patent foramen ovale closure: A single-center experience

Background

An increasing number of studies have proved that patent foramen ovale (PFO) occlusion could reduce the incidence of recurrent stroke more than drug therapy alone under certain conditions. Which is the "best" guidance technique still remains to be discussed.

Methods

A single center retrospective study enrolled 120 patients (mean age 52.51 ± 14.29 years) who underwent PFO closure between April 2019 and March 2021. 87 patients (72.5%) had suffered cryptogenic stroke (CS) at least one time, and 24 patients (20%) had repetitive episodes of hemicrania unsourced. 65 patients were in the transesophageal echocardiography (TEE) guidance group (T-group), and the other 55 patients were in the angiographic guidance group (A-group).

Results

There were no significant differences in crucial clinical characteristics between the two groups. In T-group, the procedural success rate was higher (100% vs. 92.7%, P = 0.028), and the procedural time was shorter (23.15 ± 13.87 vs. 25.75 ± 7.19, P = 0.001). No difference was detected in the procedural complication rate. Follow-up were performed at least 12 months. At 12 months, new atrial fibrillation occurred in 1 patient (1.5%) in the T-group and in 1 patient (1.8%) in the A-group (P = 0.905). Residual shunt occurred in 1 patient (1.5%) in the T-group and in 3 patients (5.5%) in the A-group (P = 0.236). Recurrent cerebral ischemia occurred in 2 patient (3.1%) in the T-group and in 2 patients (3.6%) in the A-group (P = 0.865).

Conclusion

The use of only intra-procedural TEE guidance for PFO closure is safe and effective. The whole procedure can be performed without fluoroscopy and contrast medium. The short and medium follow-up results are satisfactory, especially in the residual shunt.

X-Ray cardiac angiographic vessel segmentation based on pixel classification using machine learning and region growing

This work proposes a pixel-classification approach for vessel segmentation in x-ray angiograms. The proposal uses textural features such as anisotropic diffusion, features based on the Hessian matrix, mathematical morphology and statistics. These features are extracted from the neighborhood of each pixel. The approach also uses the ELEMENT methodology, which consists of creating a pixel-classification controlled by region-growing where the result of the classification affects further classifications of pixels. The Random Forests classifier is used to predict whether the pixel belongs to the vessel structure. The approach achieved the best accuracy in the literature (95.48%) outperforming unsupervised state-of-the-art approaches.

Intravascular Ultrasound Assessment and Correlation With Angiographic Findings of Arterial Dissections Following Auryon Laser Atherectomy and Adjunctive Balloon Angioplasty: Results of the iDissection Auryon Laser Study

BACKGROUND

Femoropopliteal arterial angiographic dissections with the use of the Auryon laser atherectomy system (previously the B-laser) have been infrequent and non-flow limiting. However, the pattern of these dissections (depth and arc) using intravascular ultrasound remains unknown.

MATERIALS AND METHODS

We prospectively enrolled 29 patients in the iDissection Auryon study. The primary objective was to define the occurrence of new adventitial injury with intravascular ultrasound (IVUS). Secondary objectives included distal embolization and bailout stenting as judged by the operator because of 30% or more residual narrowing and/or NHLBI (National Heart, Lung, and Blood Institute) angiographic dissection C and higher. Core laboratory analysis was carried on all cases except for 1 patient (that crossed over to Jetstream atherectomy). Dissections were classified according to the iDissection classification as involving the intima (A), media (B), and adventitia (C) and ≤ 180-° arc (1) or >180-° arc (2). Overall, 22 of 29 patients had an embolic filter (per protocol).

RESULTS

Median lesion and treated lengths were 100.0 and 150.0 mm, respectively. Vessel diameter by IVUS was 6.5 ± 1.5 mm. Chronic total occlusion (CTO) was present in 24.1% of cases. The arc of calcium was: no calcium in 27.6%, <90° in 13.8%, 90° to 180° in 20.7%, and >180° in 34.4%. Lesion severity was reduced to a median of 14% post laser and adjunctive percutaneous transluminal angioplasty (PTA) from a baseline of 76%. Bailout stenting occurred in 6 of 28 (21.4%) patients (3 for dissections, 2 for residual >30%, and 1 for both) and primary stenting in 1 of 28 (3.6%). By IVUS, there were 9 new dissections post laser (1 adventitial; 3≥180°) and 21 new dissections post laser and PTA (3 adventitial; 1≥180°). No distal embolization requiring treatment was seen and no macrodebris ≥2 mm was recovered in the filters.

CONCLUSION

The Auryon laser atherectomy system had minimal rate of adventitial injury despite complex disease with relatively low bailout stent rate and no clinically significant macrodebris.

Clinical and Angiographic Prophesy of Hemodynamic Status in Patients with Acute Anterior Wall ST-Segment-Elevation Myocardial Infarction and Totally Occluded Left Anterior Descending Artery

Background

Left anterior descending artery (LAD) is the most common occluded vessel in a patient presenting with acute anterior wall ST-segment elevated myocardial infarction (STEMI). Acute occlusion of LAD usually results in hemodynamic compromise. However, some patients maintain hemodynamic stability despite its proximal occlusion. As the factors associated with hemodynamic status in such patients are poorly understood, our study sought to determine the clinical and angiographic parameters associated with hemodynamic stability in these patients.

Methods

In this prospective observational study, 60 consecutive patients of acute anterior wall STEMI with completely occluded LAD on coronary angiography were included. Various clinical and angiographic parameters associated with hemodynamic status were evaluated.

Results

Of the 60 patients, 30 patients each were included in the hemodynamically stable (group I) and hemodynamically unstable group (group II). The mean age of the patients in group I and group II was 51.07±13.78 years and 55.47±11.69 years, respectively. The hemodynamically unstable group had a significantly higher number of patients with diabetes mellitus, elevated Troponin T level, and lower left ventricular ejection fraction as compared to the stable group (p<0.05). In contrast, 11 (36.7%) patients in the hemodynamically stable group had rich collaterals compared to 4 (13.3%) patients in the hemodynamically unstable group. The difference was statistically significant (p=0.037).

Conclusion

The present study showed that the presence of diabetes, severe LV systolic dysfunction, elevated Troponin-T level, and poor collaterals were associated with hemodynamic instability, whereas the presence of better collaterals predicted hemodynamic stability in patients presenting with anterior wall STEMI and total LAD occlusion.

A Study of Correlation of Angiographic Evaluation of Coronary Artery Disease with Androgenetic Alopecia - TricoHeart Study

Background:

Research on the association between androgenetic alopecia (AGA) and coronary artery disease (CAD) in women, with a focus on the evaluation of their angiographic association in the form of the severity of disease, has been lacking.

Aim:

The study aimed to evaluate the relation between CAD and AGA in women and to study their severity.

Methods:

This study, carried out with 438 women within 55 years of age and admitted for coronary angiography, had the case group (participants with CAD; n = 219) and control group (those without CAD; n = 219). The clinical and paraclinical data were collected after clinical history, physical examination, and review of the patients' records (family, past, and personal history of the participants). The coronary risk profiles such as diabetes mellitus, blood pressure, and serum cholesterol level were also noted, and the diagnosis of AGA was performed, and participants were grouped using the Ludwig's baldness grading system. Statistical analysis was performed by studying association between the variable using the Chi-square test (R i386.3.5.1 software).

Results:

In the study group, 74 (33.79%) participants were treadmill test positive, 55 (25.11%) had unstable angina, 40 (18.26%) had ST-segment elevation myocardial infarction (STEMI), and 50 (22.83%) had non-ST-STEMI (NSTEMI). In the case group, Grade II female AGA was evidenced in 38 (43.18%) participants, whereas Grade III was present in 30 (34.09%) participants. Further on, 27 patients with triple vessel disease had Grade III female AGA. Whereas, in the control group, Grade I female AGA was evidenced in 23 (65.71%) participants.

Conclusion:

The hypothesis that female pattern baldness is a marker for increased risk of CAD events has been studied and established as part of the present study. Further, extensive studies on the effect of other variables with a larger sample size need to be conducted.

Role of transesophageal echocardiography in the clinical management of a patients with a giant coronary artery aneurysm

Transthoracic echocardiography (TTE) has substantial limitations for the study of abnormalities of the coronary tree. Transesophageal echocardiography (TEE) allows a more complete examination of the coronary arteries, particularly the proximal segments. This report describes the use of TEE after cardiac catheterization in the clinical management of a patient with unstable angina. While angiography first showed the giant aneurysm of the left circumflex coronary artery. TEE, by revealing an active thrombus of the lumen, prompted an immediate surgical resolution.