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Progress in Cardiovascular Diseases Jun 2024Calcific coronary artery stenosis is a complex disease associated with adverse outcomes and suboptimal percutaneous treatment. Calcium plaque modification has emerged as... (Review)
Review
Calcific coronary artery stenosis is a complex disease associated with adverse outcomes and suboptimal percutaneous treatment. Calcium plaque modification has emerged as a key strategy to tackle the issues that accompany calcific stenosis - namely reduced device deliverability, unpredictable lesion characteristics, and difficult dilatation. Atherectomy has traditionally been the treatment modality of choice for heavily calcified coronary stenoses. Contemporary technologies have emerged to aid with planning, preparation, and treatment of calcified coronary stenosis in an attempt to improve procedural success and long-term outcomes. In this State Of The Art Review, we synthesize the body of data surrounding the diagnosis, imaging, and treatment of calcific coronary disease, with a focus on i) intravascular imaging, ii) calcific lesion preparation, iii) treatment modalities including atherectomy, and iv) updated treatment algorithms for the management of calcified coronary stenosis.
PubMed: 38925256
DOI: 10.1016/j.pcad.2024.06.007 -
Pacing and Clinical Electrophysiology :... Jun 2024New antithrombotic medications and improved stent designs have reduced branch occlusion, although the sino-atrial nodal artery (SANA) may still be occluded after a... (Review)
Review
BACKGROUND
New antithrombotic medications and improved stent designs have reduced branch occlusion, although the sino-atrial nodal artery (SANA) may still be occluded after a percutaneous coronary intervention (PCI), causing sinus node dysfunction (SND). Ischemic sinus nodes are usually asymptomatic but can cause sinus arrest sometimes requiring pacemaker placement. In rare cases, junctional escape rhythms, a manifestation of sinus exit blocks after PCI, can predict cardiogenic shock.
METHODS
We present a case study of a patient who underwent bifurcation PCI to the LMCA to the LCX but subsequently developed cardiogenic shock as a result of SND, a junctional escape rhythm required substantial inotropic support. This case offers an exemplification of a sparsely documented, yet infrequent manifestation of iatrogenic ischemic SND at an unorthodox site, the confluence of the LMCA-LCX. In addition, we conducted a comprehensive analysis of 22 scholarly works pertaining to the subject of sinus node dysfunction (SND) subsequent to PCI resulting from ischemia caused by stenosis or occlusion of the SANA.
RESULTS
RCA was responsible for 96.1% of SND cases, whereas LCX was responsible for 3.9%. SND was asymptomatic in 49.3% of cases and junctional escape rhythm in 37.6% of symptomatic cases. 28% needed a temporary transvenous pacemaker, while 7.8% needed a permanent one. Interventional management recanalized the SANA in 5.2% of patients, restoring flow.
CONCLUSION
Transient sino-atrial node ischemia after PCI can cause acute SND. Before stent implantation, doctors should consider SND. Complete plaque evaluation around the SANA is needed before choosing the best PCI procedure.
PubMed: 38923028
DOI: 10.1111/pace.15029 -
Current Issues in Molecular Biology Jun 2024Autoantibodies against apolipoprotein A-I (ApoA-I) are associated with cardiovascular disease risks. We aimed to examine the 4-hydroxy-2-nonenal (HNE) modification of...
Low Levels of IgM Recognizing 4-Hydroxy-2-Nonenal-Modified Apolipoprotein A-I Peptide and Its Association with the Severity of Coronary Artery Disease in Taiwanese Patients.
Autoantibodies against apolipoprotein A-I (ApoA-I) are associated with cardiovascular disease risks. We aimed to examine the 4-hydroxy-2-nonenal (HNE) modification of ApoA-I in coronary artery disease (CAD) and evaluate the potential risk of autoantibodies against their unmodified and HNE-modified peptides. We assessed plasma levels of ApoA-I, HNE-protein adducts, and autoantibodies against unmodified and HNE-peptide adducts, and significant correlations and odds ratios (ORs) were examined. Two novel CAD-specific HNE-peptide adducts, ApoA-I and ApoA-I, were identified. Notably, immunoglobulin G (IgG) anti-ApoA-I HNE, IgM anti-ApoA-I HNE, IgG anti-ApoA-I, IgG anti-ApoA-I, and HNE-protein adducts were significantly correlated with triglycerides, creatinine, or high-density lipoprotein in CAD with various degrees of stenosis (<30% or >70%). The HNE-protein adduct (OR = 2.208-fold, = 0.020) and IgM anti-ApoA-I HNE (2.046-fold, = 0.035) showed an increased risk of progression from >30% stenosis in CAD. HNE-protein adducts and IgM anti-ApoA-I HNE may increase the severity of CAD at high and low levels, respectively.
PubMed: 38921045
DOI: 10.3390/cimb46060374 -
Stroke Jun 2024Asymptomatic high-grade carotid stenosis is an important therapeutic target for stroke prevention. For decades, the ACAS (Asymptomatic Carotid Atherosclerosis Study) and... (Review)
Review
Asymptomatic high-grade carotid stenosis is an important therapeutic target for stroke prevention. For decades, the ACAS (Asymptomatic Carotid Atherosclerosis Study) and ACST (Asymptomatic Carotid Surgery Trial) trials provided most of the evidence supporting endarterectomy for patients with asymptomatic high-grade stenosis who were otherwise good candidates for surgery. Since then, transfemoral/transradial carotid stenting and transcarotid artery revascularization have emerged as alternatives to endarterectomy for revascularization. Advances in treatments against atherosclerosis have driven down the rates of stroke in patients managed without revascularization. SPACE-2 (Stent-Protected Angioplasty Versus Carotid Endarterectomy-2), a trial that included endarterectomy, stenting, and medical arms, failed to detect significant differences in stroke rates among treatment groups, but the study was stopped well short of its recruitment goal. CREST-2 (Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial) will be able to clarify whether revascularization by stenting or endarterectomy remains efficacious under conditions of intensive medical management. Transcarotid artery revascularization has a favorable periprocedural risk profile, but randomized trials comparing it to intensive medical management are lacking. Features like intraplaque hemorrhage on MRI and echolucency on B-mode ultrasonography can identify patients at higher risk of stroke with asymptomatic stenosis. High-grade stenosis with poor collaterals can cause hemispheric hypoperfusion, and unstable plaque can cause microemboli, both of which may be treatable risk factors for cognitive impairment. Evidence that there are patients with carotid stenosis who benefit cognitively from revascularization is presently lacking. New risk factors are emerging, like exposure to microplastics and nanoplastics. Strategies to limit exposure will be important without specific medical therapies.
PubMed: 38920049
DOI: 10.1161/STROKEAHA.124.046956 -
Cureus Jun 2024Takotsubo cardiomyopathy (TC) mimics myocardial infarction with symptoms like chest pain, electrocardiogram (EKG) changes, and elevated troponin levels, although it...
Case Report and Literature Review of an Anomalous Course of the Left Main Coronary Artery (LMCA) Arising From the Right Sinus of Valsalva (RSV) Presenting as Takotsubo Cardiomyopathy.
Takotsubo cardiomyopathy (TC) mimics myocardial infarction with symptoms like chest pain, electrocardiogram (EKG) changes, and elevated troponin levels, although it typically features normal coronary arteries upon angiography. While often asymptomatic, coronary artery anomalies (CAAs) can cause intermittent vasospasm and endothelial dysfunction, potentially inducing TC. We report the case of a 74-year-old female with a history of hypertension, hyperlipidemia, and peripheral artery disease, who presented with sudden onset chest pain. Initial EKG and elevated troponin suggested myocardial infarction. However, coronary angiography revealed an anomalous left main coronary artery (LMCA) originating from the right coronary artery (RCA), with no significant stenosis. Subsequent transthoracic echocardiography indicated TC, with the left ventricular ejection fraction improving from 35-40% to 60-65% within days. Cardiac computed tomography angiography (CCTA) revealed that the anomalous LMCA originated from the common trunk at the right sinus of Valsalva (RSV), which further continued as a large, dominant RCA. The LMCA branched into a small to moderate left anterior descending artery (LAD) and a non-dominant left circumflex artery (LCx). The LMCA followed a prepulmonic/anterior course, while the LCx took an interarterial course between the aorta and pulmonary artery. The patient was referred for further surgical evaluation. We conclude that the CAA was an incidental finding and was not related to underlying TC. Although rare, this case suggests a possible correlation between CAAs and a predisposition to stress-induced cardiomyopathy, warranting further investigation.
PubMed: 38919862
DOI: 10.7759/cureus.63028 -
Journal of Inflammation Research 2024The inflammatory response is a pivotal factor in accelerating the progression of atherosclerosis. The high-sensitivity C-reactive protein-to-albumin ratio (CAR) has...
BACKGROUND
The inflammatory response is a pivotal factor in accelerating the progression of atherosclerosis. The high-sensitivity C-reactive protein-to-albumin ratio (CAR) has emerged as a novel marker of systemic inflammation. However, few studies have shown the CAR to be a promising prognostic marker for carotid atherosclerotic disease. This study aimed to analyse the predictive role of the CAR in carotid atherosclerotic disease.
METHODS
This community-based cohort study recruited 2003 participants from the Rose asymptomatic IntraCranial Artery Stenosis (RICAS) study who were free of stroke or transient ischemic attack. Carotid atherosclerotic plaques and their stability were identified via carotid ultrasound. Logistic regression models were utilized to investigate the association between CAR and the presence of carotid atherosclerotic plaques.
RESULTS
The prevalence of carotid atherosclerotic plaques was 38.79% in this study. After adjusting for clinical risk factors, including sex, age, dyslipidemia, hypertension, diabetes mellitus (DM), and smoking and drinking habits, a high CAR-level was independently associated with carotid plaque (odds ratio [OR] of upper: 1.46, 95% confidence interval [CI]: 1.13-1.90, = 0.004; for trend = 0.011). The highest CAR tertile was still significantly associated with carotid plaques among middle-aged (40-64 years) or female participants. Notably, an elevated CAR may be an independent risk factor for vulnerable carotid plaques (OR of upper: 2.06, 95% CI: 1.42-2.98, < 0.001; for trend <0.001).
CONCLUSION
A high CAR may be correlated with a high risk of carotid plaques, particularly among mildly aged adults (40-64 years) or females. Importantly, the CAR may be associated with vulnerable carotid plaques, suggesting that the CAR may be a new indicator for stroke prevention.
PubMed: 38919510
DOI: 10.2147/JIR.S464491 -
Indian Journal of Thoracic and... Jul 2024Prolonged ventilation remains the most common cause of tracheal stenosis. Tracheal reconstruction is the gold standard treatment in these cases. The success of surgery...
Prolonged ventilation remains the most common cause of tracheal stenosis. Tracheal reconstruction is the gold standard treatment in these cases. The success of surgery is based on results of the pulmonary function test (PFT) which relies on patients' performance and their cooperation. The objective of the study was to investigate the impact of tracheal reconstruction in cases of tracheal stenosis on blood gas indices as well as airflow indices and whether arterial blood gas (ABG) can be a better surrogate of adequacy of tracheal reconstruction. This was a retrospective observational study of 61 patients with tracheal stenosis between the ages of 21 and 65 years who underwent tracheal reconstruction. The preoperative and postoperative values of various blood gas indices like partial pressure of oxygen (pO), partial pressure of carbon dioxide (pCO), and potential of hydrogen (pH) and airflow indices like forced expiratory volume in 1 s (FEV1) and peak expiratory flow (PEF) were evaluated and found that all the parameters showed significant improvement after tracheal reconstruction with < 0.0001. Tracheal reconstruction resulted in improvement of oxygenation and airflow parameters which led to relief of symptoms. Hence, ABG can be used as a surrogate marker for denoting the success of the surgery.
PubMed: 38919188
DOI: 10.1007/s12055-024-01694-w -
Scientific Reports Jun 2024Cerebrovascular resistance (CVR) regulates blood flow in the brain, but little is known about the vascular resistances of the individual cerebral territories. We present...
Cerebrovascular resistance (CVR) regulates blood flow in the brain, but little is known about the vascular resistances of the individual cerebral territories. We present a method to calculate these resistances and investigate how CVR varies in the hemodynamically disturbed brain. We included 48 patients with stroke/TIA (29 with symptomatic carotid stenosis). By combining flow rate (4D flow MRI) and structural computed tomography angiography (CTA) data with computational fluid dynamics (CFD) we computed the perfusion pressures out from the circle of Willis, with which CVR of the MCA, ACA, and PCA territories was estimated. 56 controls were included for comparison of total CVR (tCVR). CVR were 33.8 ± 10.5, 59.0 ± 30.6, and 77.8 ± 21.3 mmHg s/ml for the MCA, ACA, and PCA territories. We found no differences in tCVR between patients, 9.3 ± 1.9 mmHg s/ml, and controls, 9.3 ± 2.0 mmHg s/ml (p = 0.88), nor in territorial CVR in the carotid stenosis patients between ipsilateral and contralateral hemispheres. Territorial resistance associated inversely to territorial brain volume (p < 0.001). These resistances may work as reference values when modelling blood flow in the circle of Willis, and the method can be used when there is need for subject-specific analysis.
Topics: Humans; Male; Female; Cerebrovascular Circulation; Hydrodynamics; Vascular Resistance; Middle Aged; Aged; Magnetic Resonance Imaging; Stroke; Carotid Stenosis; Hemodynamics; Computed Tomography Angiography; Circle of Willis; Blood Flow Velocity; Brain
PubMed: 38918589
DOI: 10.1038/s41598-024-65431-4 -
Biomechanics and Modeling in... Jun 2024Pulmonary artery stenosis (PAS) often presents in children with congenital heart disease, altering blood flow and pressure during critical periods of growth and...
Pulmonary artery stenosis (PAS) often presents in children with congenital heart disease, altering blood flow and pressure during critical periods of growth and development. Variability in stenosis onset, duration, and severity result in variable growth and remodeling of the pulmonary vasculature. Computational fluid dynamics (CFD) models enable investigation into the hemodynamic impact and altered mechanics associated with PAS. In this study, a one-dimensional (1D) fluid dynamics model was used to simulate hemodynamics throughout the pulmonary arteries of individual animals. The geometry of the large pulmonary arteries was prescribed by animal-specific imaging, whereas the distal vasculature was simulated by a three-element Windkessel model at each terminal vessel outlet. Remodeling of the pulmonary vasculature, which cannot be measured in vivo, was estimated via model-fitted parameters. The large artery stiffness was significantly higher on the left side of the vasculature in the left pulmonary artery (LPA) stenosis group, but neither side differed from the sham group. The sham group exhibited a balanced distribution of total distal vascular resistance, whereas the left side was generally larger in the LPA stenosis group, with no significant differences between groups. In contrast, the peripheral compliance on the right side of the LPA stenosis group was significantly greater than the corresponding side of the sham group. Further analysis indicated the underperfused distal vasculature likely moderately decreased in radius with little change in stiffness given the increase in thickness observed with histology. Ultimately, our model enables greater understanding of pulmonary arterial adaptation due to LPA stenosis and has potential for use as a tool to noninvasively estimate remodeling of the pulmonary vasculature.
PubMed: 38918266
DOI: 10.1007/s10237-024-01850-6 -
Frontiers in Neurology 2024The safety and efficacy of dual antiplatelet therapy (DAPT) in ischemic stroke patients with intracranial artery stenosis (ICAS) remain contentious.
BACKGROUND
The safety and efficacy of dual antiplatelet therapy (DAPT) in ischemic stroke patients with intracranial artery stenosis (ICAS) remain contentious.
AIMS
This study evaluates DAPT's effectiveness and safety for these patients.
METHODS
This review was reported following PRISMA 2020 guidelines. A comprehensive search was conducted in PubMed, Embase, Cochrane Library, ClinicalTrials.gov, CNKI, WanFang, VIP, and SinoMed up to June 20, 2023, for randomized controlled trials comparing efficacy and safety of DAPT against single antiplatelet therapy (SAPT) in ischemic stroke patients with ICAS. The primary outcome was a composite of ischemic and bleeding events. Secondary outcomes included stroke (cerebral infarction and hemorrhage), ischemic events, and cerebral infarction. Safety outcomes assessed were bleeding events, cerebral hemorrhage, and mortality. Risk ratios (RRs) with 95% confidence intervals (CIs) were synthesized using Review Manager 5.4.
RESULTS
Analysis of 21 randomized controlled trials involving 3,591 patients revealed that DAPT significantly lowered the rate of ischemic and bleeding events (RR = 0.52; 95% CI: 0.46-0.59, < 0.001) and recurrent stroke (RR = 0.37; 95% CI: 0.30-0.44, < 0.001) compared to SAPT. There was no significant increase in bleeding events (RR = 1.34; 95% CI: 0.97-1.85, = 0.07) or cerebral hemorrhage (RR = 0.47; 95% CI: 0.17-1.31, = 0.15).
CONCLUSION
DAPT proveed to be effective and safe for ischemic stroke patients with ICAS and significantly reduced stroke and the composite endpoint of ischemic and bleeding events without elevating bleeding risks.
PubMed: 38915797
DOI: 10.3389/fneur.2024.1411669