RESUMEN
INTRODUCTION: Aortic arch complex atheromatosis is a source of cerebral embolism. A percentage of lacunar infarct could be of embolic etiology, especially due to microemboli of the aortic arch. CASE REPORT: We present the case of a 63-year-old hypertensive man suffering from dysarthria-clumsy hand syndrome for a right hemispheric minor ischemic stroke. The patient developed sequential acute thromboembolism of the left lower and right upper limbs. Computed tomography angiography revealed an aortic arch thrombus. Vascular surgery was successfully performed. CONCLUSION: This case highlights the importance of considering embolic sources in lacunar syndromes, especially at the level of the aortic arch.
TITLE: Síndrome de disartria-mano torpe y embolias agudas secuenciales múltiples de las extremidades como forma de presentación de un trombo del cayado aórtico.Introducción. La ateromatosis del complejo del arco aórtico es una fuente de embolia cerebral. Un porcentaje de infartos lacunares podría ser de etiología embólica, especialmente debidos a microembolias del arco aórtico. Caso clínico. Presentamos el caso de un varón hipertenso de 63 años con síndrome de disartria-mano torpe por un ictus isquémico minor hemisférico derecho. El paciente desarrolló un tromboembolismo agudo secuencial de los miembros inferior izquierdo y superior derecho. La angiografía por tomografía computarizada reveló un trombo en el arco aórtico. La cirugía vascular se llevó a cabo con éxito. Conclusión. Este caso destaca la importancia de considerar las fuentes embólicas en los síndromes lacunares, especialmente en el arco aórtico.
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Aorta Torácica , Disartria , Humanos , Masculino , Persona de Mediana Edad , Disartria/etiología , Aorta Torácica/diagnóstico por imagen , Mano/irrigación sanguínea , Síndrome , Enfermedad Aguda , Enfermedades de la Aorta/diagnóstico por imagen , Enfermedades de la Aorta/complicacionesRESUMEN
We compared the computed tomography (CT) numbers from monochromatic images obtained using the first-generation (Discovery CT750 HD: GE Healthcare, Milwaukee, WI) and second-generation (Revolution CT: GE HealthCare) dual-energy CT (first and second DECT) scanners in phantom and clinical studies. In a polypropylene phantom, eight polypropylene tubes containing iodine at various concentrations (0.5, 1, 2, 5, 10, 12, 20, 30 mg I per ml) were arranged in an outer circle. The iodine densities and CT numbers obtained after imaging with different-generation DECT scanners were analyzed. The CT numbers from images obtained from 61 consecutive patients with aortic disease who underwent CT with different-generation DECT scanners were compared during the arterial and delayed phases. The iodine concentration obtained from second DECT was more accurate than that from the first DECT in the phantom study. A significantly higher contrast enhancement was observed with the second DECT compared with the first DECT during the arterial phase in the clinical study. Contrast enhancement was higher with the second DECT than with the first DECT, and the second DECT was effective in minimizing the use of contrast materials.
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Medios de Contraste , Yodo , Fantasmas de Imagen , Tomografía Computarizada por Rayos X , Humanos , Medios de Contraste/química , Tomografía Computarizada por Rayos X/métodos , Masculino , Femenino , Anciano , Imagen Radiográfica por Emisión de Doble Fotón/métodos , Persona de Mediana Edad , Anciano de 80 o más Años , Tomógrafos Computarizados por Rayos X , Enfermedades de la Aorta/diagnóstico por imagen , Dosis de RadiaciónRESUMEN
BACKGROUND: High-fidelity cardiac magnetic resonance (MR) imaging plays a pivotal role in the surveillance of congenital heart disease (CHD) and aortopathy. OBJECTIVE: We aimed to evaluate the quality and accuracy of free breathing, ECG-gated noncontrast three-dimensional (3D) balanced steady-state free precession (bSSFP) in cases of CHDs and aortopathies using contrast-enhanced 3D bSSFP as a reference. We also used one of our routinely used non-ECG-gated 2D-single-shot (SSh) bSSFP sequence as an adjunct to noncontrast 3D bSSFP. MATERIALS AND METHODS: Institutional review board approval was obtained to perform a systematic retrospective analysis of image quality and vascular measurements. Patients with CHD and aortopathy, who were undergoing clinically indicated contrast-enhanced 3D bSSFP, were prospectively identified to also undergo additional noncontrast 3D bSSFP and 2D SSh bSSFP imaging as part of a clinical quality improvement initiative aimed at reducing the use of contrast when feasible. Two readers, blinded to each other's evaluations, graded image quality on a 5-point Likert scale and performed vascular measurements in separate sessions for both 3D bSSFP images. They also reported the visibility of various mediastinal great vessels on 2D SSh bSSFP images. Raw agreement, the weighted kappa statistic, and intra-class correlation coefficients (ICCs) were computed to assess the consistency and agreement between the two readers. Comparative analysis of noncontrast and contrast-enhanced 3D bSSFP imaging was performed in adult and pediatric patients using a two-sided paired t-test and Bland-Altman analysis. A P-value < 0.05 was considered significant for all inference testing. RESULTS: A total of 29 patients (17 males, median age 20.3 years, interquartile range (IQR) 12.5, age range 7-39 years), including 11 pediatric patients under the age of 18 years (6 males, median age 14.5 years, IQR 4.0, age range 7-17 years), underwent retrospective analysis. The overall image quality score for contrast-enhanced 3D bSSFP was significantly higher (P < 0.0001) than that of noncontrast 3D bSSFP for both all subjects (4.4 ± 0.2, range 4.0-4.9 vs 3.7 ± 0.4, range 3.1-4.7) and only pediatric subjects (4.3 ± 0.3, range 4.0-4.9 vs 3.6 ± 0.5, range 3.1-4.4). By combining noncontrast 3D bSSFP and 2D bSSFP, reader 1 and reader 2 rated 423 and 420 vessels diagnostic, respectively, in a total of 435 vessel segments. All landmarks showed similar mean vessel diameters without significant differences between noncontrast and contrast-enhanced 3D bSSFP MR angiography (r = 0.99, bias -0.31 mm, 95% limits of agreement -2.04 mm to 1.43 mm). CONCLUSIONS: Although contrast-enhanced images had better overall image quality, an imaging protocol consisting of noncontrast 2D SSh bSSFP and 3D bSSFP whole-chest images provides diagnostically adequate image quality, and accurate vascular measurements, comparable to free-breathing contrast-enhanced 3D bSSFP in both children and adults with CHD and aortopathies.
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Enfermedades de la Aorta , Técnicas de Imagen Sincronizada Cardíacas , Cardiopatías Congénitas , Imagenología Tridimensional , Humanos , Cardiopatías Congénitas/diagnóstico por imagen , Imagenología Tridimensional/métodos , Masculino , Niño , Femenino , Adolescente , Técnicas de Imagen Sincronizada Cardíacas/métodos , Enfermedades de la Aorta/diagnóstico por imagen , Reproducibilidad de los Resultados , Adulto , Estudios Retrospectivos , Preescolar , Electrocardiografía/métodos , Medios de Contraste , Sensibilidad y Especificidad , Lactante , Adulto Joven , Interpretación de Imagen Asistida por Computador/métodos , Aumento de la Imagen/métodosAsunto(s)
Aorta Torácica , Recurrencia , Humanos , Aorta Torácica/diagnóstico por imagen , Calcificación Vascular/diagnóstico por imagen , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/etiología , Enfermedades de la Aorta/diagnóstico por imagen , Masculino , Radiografía Torácica , Calcinosis/diagnóstico por imagen , Femenino , Tomografía Computarizada por Rayos X , AncianoAsunto(s)
Cateterismo Periférico , Procedimientos Endovasculares , Arteria Ilíaca , Arteria Radial , Humanos , Arteria Radial/diagnóstico por imagen , Arteria Ilíaca/diagnóstico por imagen , Arteria Ilíaca/fisiopatología , Cateterismo Periférico/efectos adversos , Procedimientos Endovasculares/instrumentación , Resultado del Tratamiento , Punciones , Factores de Riesgo , Enfermedades de la Aorta/diagnóstico por imagen , Enfermedades de la Aorta/terapia , Enfermedades de la Aorta/fisiopatologíaAsunto(s)
Aorta Torácica , Aprendizaje Profundo , Calcificación Vascular , Humanos , Aorta Torácica/diagnóstico por imagen , Calcificación Vascular/diagnóstico por imagen , Masculino , Algoritmos , Femenino , Anciano , Enfermedades de la Aorta/diagnóstico por imagen , Cateterismo/métodos , Persona de Mediana EdadRESUMEN
BACKGROUND: Thromboembolic events, particularly strokes, remain a major complication of transcatheter aortic valve replacement (TAVR). Embolic protection devices have failed to show significant clinical benefit in large randomized clinical trials. Aortic wall thrombus (AWT) is often observed on multidetector computed tomography during TAVR work-up, but its prognostic significance is uncertain. OBJECTIVES: This study sought to evaluate the association between the presence of AWT and the incidence of thromboembolic outcomes in patients undergoing transfemoral (TF) TAVR for severe aortic stenosis. METHODS: This was a prospective cohort study of consecutive patients who underwent TF TAVR for severe aortic stenosis between January 2011 and April 2022. A dedicated scale (range: 0-10) was qualitatively used to assess AWT. The primary outcome was a composite of procedural thromboembolic events defined as ischemic stroke, blue toe syndrome, bowel ischemia, or other solid organ infarction. The secondary endpoints were ischemic strokes and procedural death. RESULTS: Of the 641 patients included, severe AWT (score ≥8) was identified in 73 (11.4%). The presence of severe AWT was strongly associated with an increase in the primary outcome (OR: 8.48; 95% CI: 3.36-21.40; P < 0.001). This relationship persisted following multivariable analysis, which adjusted for comorbidities and procedural characteristics. The presence of severe AWT was also found to be associated with an increased incidence of stroke and procedural death (OR: 5.66; 95% CI: 2.00-15.30; P = 0.002 and OR: 4.66; 95% CI: 1.80-11.30; P = 0.002, respectively). CONCLUSIONS: The presence of severe AWT on preprocedural multidetector computed tomography is strongly associated with thromboembolic complications including stroke and mortality after TF TAVR.
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Estenosis de la Válvula Aórtica , Arteria Femoral , Índice de Severidad de la Enfermedad , Tromboembolia , Trombosis , Reemplazo de la Válvula Aórtica Transcatéter , Humanos , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Reemplazo de la Válvula Aórtica Transcatéter/mortalidad , Reemplazo de la Válvula Aórtica Transcatéter/instrumentación , Femenino , Masculino , Anciano de 80 o más Años , Estenosis de la Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/mortalidad , Estudios Prospectivos , Factores de Riesgo , Anciano , Arteria Femoral/diagnóstico por imagen , Trombosis/diagnóstico por imagen , Trombosis/etiología , Trombosis/mortalidad , Trombosis/epidemiología , Resultado del Tratamiento , Tromboembolia/etiología , Tromboembolia/diagnóstico por imagen , Tromboembolia/mortalidad , Tromboembolia/prevención & control , Incidencia , Medición de Riesgo , Factores de Tiempo , Válvula Aórtica/cirugía , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/fisiopatología , Tomografía Computarizada Multidetector , Cateterismo Periférico/efectos adversos , Cateterismo Periférico/mortalidad , Enfermedades de la Aorta/diagnóstico por imagen , Enfermedades de la Aorta/mortalidad , PuncionesRESUMEN
BACKGROUND: Despite advances in diagnostic and treatment modalities, there is a need for predictive markers for recurrent strokes. OBJECTIVES: This study aimed to investigate the relationship between aortic arch calcification (AAC) and stroke recurrence in stroke patients during a one-year follow-up. METHODS: All stroke patients who experienced their first event were evaluated for participation in the study. Patients who experienced recurrent strokes during the one-year follow-up were recorded. AAC was assessed by chest radiography. Based on the occurrence of recurrent strokes the patients were divided into two groups. AAC was classified into four categories according to its degree, and the presence of AAC was included in the statistical analysis. The relationship between AAC and recurrent stroke was assessed using a receiver operating characteristic curve. A significance level of <0.05 was deemed acceptable for all statistical analyses. RESULTS: A total of 203 patients were included in the study (46.8% female, mean age 69±12.3). Recurrent stroke was detected in 49 patients. AAC, hypertension, and atrial fibrillation were more frequent in patients with recurrent stroke. Patients with recurrent stroke had a lower glomerular filtration rate and a higher red cell distribution width (RDW). In multivariate regression analysis, AAC (hazard ratio [HR], 3.544; 95% CI:1.653-7.598, p=0.001) and RDW (HR,1.214; 95% CI:1.053-1.400, p=0.008) were identified as independent predictors of recurrent stroke. CONCLUSION: The presence of AAC (≥ grade 1) and RDW were found to be significantly associated with the development of recurrent stroke within one year. These findings may have prognostic significance in the follow-up of stroke patients.
FUNDAMENTO: Apesar dos avanços nas modalidades de diagnóstico e tratamento, há necessidade de marcadores preditivos para acidente vascular cerebral (AVC) recorrentes. OBJETIVOS: Este estudo teve como objetivo investigar a relação entre calcificação do arco aórtico (CAA) e recorrência de AVC em pacientes com AVC durante o acompanhamento de um ano. MÉTODOS: Todos os pacientes com AVC que sofreram seu primeiro evento foram avaliados para participação no estudo. Foram registrados pacientes que sofreram AVC recorrentes durante o acompanhamento de um ano. A CAA foi avaliada por radiografia de tórax. Com base na ocorrência de AVC recorrente, os pacientes foram divididos em dois grupos. A CAA foi classificada em quatro categorias de acordo com o seu grau, e a presença de CAA foi incluída na análise estatística. A relação entre CAA e AVC recorrente foi avaliada por meio de uma curva característica de operação do receptor. Um nível de significância <0,05 foi considerado aceitável para todas as análises estatísticas. RESULTADOS: Um total de 203 pacientes foram incluídos no estudo (46,8% mulheres, média de idade 69±12,3). AVC recorrente foi detectado em 49 pacientes. CAA, hipertensão e fibrilação atrial foram mais frequentes em pacientes com AVC recorrente. Pacientes com AVC recorrente apresentaram menor taxa de filtração glomerular e maior largura de distribuição de glóbulos vermelhos (RDW). Na análise de regressão multivariada, CAA (hazard ratio [HR], 3,544; IC 95%:1,653-7,598, p=0,001) e RDW (HR,1,214; IC 95%:1,053-1,400, p=0,008) foram identificados como preditores independentes de AVC recorrente. CONCLUSÃO: A presença de CAA (≥ grau 1) e RDW foram significativamente associadas ao desenvolvimento de AVC recorrente dentro de um ano. Esses achados podem ter significado prognóstico no acompanhamento de pacientes com AVC.
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Aorta Torácica , Recurrencia , Accidente Cerebrovascular , Humanos , Femenino , Masculino , Aorta Torácica/diagnóstico por imagen , Anciano , Accidente Cerebrovascular/diagnóstico por imagen , Persona de Mediana Edad , Factores de Riesgo , Calcificación Vascular/diagnóstico por imagen , Enfermedades de la Aorta/diagnóstico por imagen , Radiografía Torácica , Anciano de 80 o más Años , Valor Predictivo de las Pruebas , Estudios de Seguimiento , Calcinosis/diagnóstico por imagenRESUMEN
BACKGROUND Cerebrovascular occlusion is a critical health concern associated with strokes, a leading cause of mortality worldwide. Large vessel occlusion, constituting a significant portion of acute ischemic strokes, presents serious patient outcomes. Occlusions involving multiple extracranial vessels are rare but pose challenges in early detection due to potential absence of overt symptoms. CASE REPORT A 65-year-old man with a significant smoking history and no prior history of hypertension or cardiovascular disease presented with recurrent generalized tonic seizures occurring 4 to 5 times daily. Despite normal neurological examinations, neck sonography indicated potential obstruction in the carotid and vertebral arteries. Conventional angiography revealed mild coronary artery plaques but complete occlusion of all cranial branches originating from the aorta, alongside porcelain aorta. Neck CT angiography confirmed complete occlusion of the supra-aortic branches of the aorta and absence of the right internal carotid artery, with evidence of proximal occlusion of the left internal carotid artery. Medical management without surgical intervention was pursued due to the patient's stable condition. He was discharged with a medication regimen including antiplatelet therapy and statins. Four-month follow-up showed significant symptom improvement, with minimal changes in brain blood flow circulation noted on CT. CONCLUSIONS This case underscores the brain's remarkable adaptive capacity in withstanding severe vascular challenges. The rarity of multiple extracranial vessel occlusions and presence of porcelain aorta further complicated the case. Utilizing advanced imaging techniques and personalized treatment approaches are crucial in managing complex vascular conditions. Ongoing research and careful monitoring are essential to advance understanding and management in such cases.
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Angiografía por Tomografía Computarizada , Humanos , Masculino , Anciano , Enfermedades de la Aorta/complicaciones , Enfermedades de la Aorta/diagnóstico por imagen , Arteriopatías Oclusivas/diagnóstico por imagenRESUMEN
OBJECTIVE: To assess the comparative safety and efficacy of covered stents (CS) and bare metal stents (BMS) in the endovascular treatment of aorto-iliac disease in patients with peripheral arterial disease. DATA SOURCES: A systematic review was conducted adhering to the PRISMA 2020 and PRISMA for Individual Participant Data 2015 guidelines. REVIEW METHODS: A search of PubMed, Scopus, and Web of Science for articles published by December 2023 was performed. The primary endpoint was primary patency. Certainty of evidence was assessed via the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. RESULTS: Eleven studies, comprising 1 896 patients and 2 092 lesions, were included. Of these, nine studies reported on patients' clinical status, with 35.5% classified as Rutherford 4 - 6. Overall primary patency for CS and BMS at 48 months was 91.2% (95% confidence interval [CI] 84.1 - 99.0%) (GRADE, moderate) and 83.5% (95% CI 70.9 - 98.3%) (GRADE, low). The one stage individual participant data meta-analyses indicated a significant risk reduction for primary patency loss favouring CS (hazard ratio [HR] 0.58, 95% CI 0.35 - 0.95) (GRADE, very low). The 48 month primary patency for CS and BMS when treating TransAtlantic Inter-Society Consensus (TASC) C and D lesions was 92.4% (95% CI 84.7 - 100%) (GRADE, moderate) and 80.8% (95% CI 64.5 - 100%) (GRADE, low), with CS displaying a decreased risk of patency loss (HR 0.39, 95% CI 0.27 - 0.57) (GRADE, moderate). While statistically non-significant differences were identified between CS and BMS regarding technical success, 30 day mortality rate, intra-operative and immediate post-operative procedure related complications, and major amputation, CS displayed a decreased re-intervention risk (risk ratio 0.59, 95% CI 0.40 - 0.87) (GRADE, low). CONCLUSION: This review has illustrated the improved patency of CS compared with BMS in the treatment of TASC C and D lesions. Caution is advised in interpreting overall primary patency outcomes given the substantial inclusion of TASC C and D lesions in the analysis. Ultimately, both stent types have demonstrated comparable safety profiles.
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Procedimientos Endovasculares , Arteria Ilíaca , Enfermedad Arterial Periférica , Stents , Grado de Desobstrucción Vascular , Humanos , Arteria Ilíaca/cirugía , Arteria Ilíaca/fisiopatología , Arteria Ilíaca/diagnóstico por imagen , Enfermedad Arterial Periférica/terapia , Enfermedad Arterial Periférica/fisiopatología , Enfermedad Arterial Periférica/cirugía , Procedimientos Endovasculares/instrumentación , Procedimientos Endovasculares/efectos adversos , Enfermedades de la Aorta/cirugía , Enfermedades de la Aorta/terapia , Enfermedades de la Aorta/diagnóstico por imagen , Enfermedades de la Aorta/mortalidad , Enfermedades de la Aorta/fisiopatología , Resultado del Tratamiento , Diseño de Prótesis , MetalesRESUMEN
BACKGROUND: Gupta Perioperative Risk for Myocardial Infarction or Cardiac Arrest (MICA) is a validated self-explanatory score applied in cardiac or noncardiac surgeries. This study aims to assess the predictive value of the MICA score for cardiovascular events after aortoiliac revascularization. METHODS: This prospective cohort underwent elective aortoiliac revascularization between 2013 and 2021. Patients' demographic, clinical characteristics, and outcomes were registered. The patients were divided into 2 groups according to the MICA score using optimal binning. Survival analysis to test for time-dependent variables and multivariate Cox regression analysis for independent predictors were performed. RESULTS: This study included 130 patients with a median follow-up of 55 months. Preoperative MICA score was ≥6.5 in 41 patients. MICA ≥6.5 presented a statistically significant association, with long-term occurrence of acute heart failure (HR = 1.695, 95% CI 1.208-2.379, P = 0.002), major adverse cardiovascular events (HR = 1.222, 95% CI 1.086-1.376, P < 0.001), and all-cause mortality (HR = 1.256, 95% CI 1.107-1.425, P < 0.001). Multivariable Cox regression confirmed MICA as a significant independent predictor of long-term major adverse cardiovascular events (aHR = 1.145 95% CI 1.010-1.298, P = 0.034) and all-cause mortality (aHR = 1.172 95% CI 1.026-1.339, P = 0.020). CONCLUSIONS: The MICA score is a quick, easy-to-obtain, predictive tool in identifying patients with a higher risk of postaortoiliac revascularization cardiovascular events, such as acute heart failure, major adverse cardiovascular events, and all-cause mortality. Additional research for the validation of the MICA score in the context of aortoiliac revascularization and specific interventions is necessary.
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Paro Cardíaco , Infarto del Miocardio , Valor Predictivo de las Pruebas , Humanos , Masculino , Femenino , Anciano , Medición de Riesgo , Persona de Mediana Edad , Factores de Tiempo , Estudios Prospectivos , Factores de Riesgo , Resultado del Tratamiento , Paro Cardíaco/mortalidad , Paro Cardíaco/diagnóstico , Paro Cardíaco/etiología , Infarto del Miocardio/mortalidad , Infarto del Miocardio/etiología , Infarto del Miocardio/diagnóstico , Arteria Ilíaca/cirugía , Arteria Ilíaca/diagnóstico por imagen , Técnicas de Apoyo para la Decisión , Enfermedad Arterial Periférica/mortalidad , Enfermedad Arterial Periférica/diagnóstico , Enfermedad Arterial Periférica/cirugía , Enfermedades de la Aorta/mortalidad , Enfermedades de la Aorta/cirugía , Enfermedades de la Aorta/diagnóstico por imagen , Enfermedades de la Aorta/complicaciones , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/mortalidadRESUMEN
This study aimed to investigate the relationship between complex aortic plaque (CAP) and short-term as well as long-term outcomes following cardioembolic stroke. CAP is a known risk factor for occurrence and recurrence of ischemic stroke. However, the association of CAP on cardioembolic stroke remains unclear. This was retrospective study using prospective cohort of consecutive patients with cardioembolic stroke who underwent transesophageal echocardiography. The functional outcome was evaluated using the modified Rankin Scale score at 3 months, and long-term outcomes were assessed by recurrence of ischemic stroke and occurrence of major adverse cardiovascular events (MACE). Among 759 patients with cardioembolic stroke, 91 (12.0%) had CAP. Early ischemic stroke recurrence within 3 months was associated with CAP (p = 0.025), whereas CAP was not associated with functional outcome at 3 months (odd ratio 1.01, 95% confidence interval [CI] 0.57-1.84, p = 0.973). During a median follow-up of 3.02 years, CAP was significantly associated with ischemic stroke recurrence (hazard ratio = 2.68, 95% CI 1.48-4.88, p = 0.001) and MACE occurrence (hazard ratio = 1.61, 95% CI 1.03-2.51, p = 0.039). In conclusion, CAP was associated with early ischemic stroke recurrence and poor long-term outcomes in patients with cardioembolic stroke. It might be helpful to consider transesophageal echocardiography for patients with cardioembolic stroke to identify CAP.
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Accidente Cerebrovascular Embólico , Accidente Cerebrovascular Isquémico , Placa Aterosclerótica , Humanos , Masculino , Femenino , Anciano , Accidente Cerebrovascular Isquémico/diagnóstico por imagen , Accidente Cerebrovascular Isquémico/etiología , Accidente Cerebrovascular Isquémico/complicaciones , Placa Aterosclerótica/complicaciones , Placa Aterosclerótica/diagnóstico por imagen , Pronóstico , Persona de Mediana Edad , Estudios Retrospectivos , Accidente Cerebrovascular Embólico/etiología , Ecocardiografía Transesofágica , Factores de Riesgo , Recurrencia , Enfermedades de la Aorta/complicaciones , Enfermedades de la Aorta/diagnóstico por imagen , Estudios Prospectivos , Anciano de 80 o más AñosRESUMEN
Background: The clinical outcomes and survival of patients with penetrating aortic ulcers (PAU) were evaluated in a tertiary care hospital, comparing those who underwent aortic repair to those treated conservatively. Patients and methods: A retrospective single-centre analysis included all patients that underwent a computed tomography angiography (CT-A) scan with the diagnosis of a PAU between January 2009 and May 2019. "PAU" was identified in 1,493 of 112,506 CT-A scan reports in 576 patients. Clinical and angiomorphological data were collected. The primary outcome was overall survival (OS), with secondary outcomes focusing on identifying risk factors for poor OS. Survival probabilities were analysed by the Kaplan-Meier method using the log-rank test. A Cox hazard model using survival as dependent variable with stepwise backward eliminations based on the likelihood ratios was employed. Results: 315 PAUs were identified in 278 patients. The prevalence in the cohort was 0.8%. The mean age of the patients was 74.4 years, and they were predominantly male (n = 208, 74.8%). The mean ulcer depth was 11.8 mm (range 2-50 mm). Out of the patients, 232 were asymptomatic (83.5%). Among 178 PAUs (56.5%), high-risk factors, such as ulcer depth >10 mm, aortic diameter >40 mm, and ulcer length >20 mm, were observed. Aortic repair was associated with a better mean OS compared to conservatively managed patients (72.6 versus 32.2 months, p = 0.001). The Cox hazard model showed that ulcer depth >1 mm was associated with poor OS (HR 0.67, p = 0.048), while aortic repair was related to a better OS (HR 4.365, p<0.013). Conclusions: Aortic repair is associated with better OS, but this finding should be interpreted with caution because of differences in age and comorbidities between the groups. Further evaluation is warranted through prospective studies with randomized groups. Further assessment for angiomorphological parameters is recommended to identify patients at increased risk for poor OS.
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Enfermedades de la Aorta , Angiografía por Tomografía Computarizada , Tratamiento Conservador , Úlcera , Humanos , Masculino , Femenino , Úlcera/mortalidad , Úlcera/diagnóstico por imagen , Úlcera/terapia , Úlcera/cirugía , Estudios Retrospectivos , Tratamiento Conservador/efectos adversos , Tratamiento Conservador/mortalidad , Anciano , Factores de Riesgo , Resultado del Tratamiento , Factores de Tiempo , Enfermedades de la Aorta/mortalidad , Enfermedades de la Aorta/diagnóstico por imagen , Enfermedades de la Aorta/terapia , Enfermedades de la Aorta/cirugía , Persona de Mediana Edad , Anciano de 80 o más Años , Medición de Riesgo , Implantación de Prótesis Vascular/mortalidad , Implantación de Prótesis Vascular/efectos adversos , Aortografía , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/mortalidad , Úlcera Aterosclerótica PenetranteRESUMEN
OBJECTIVE: The outcomes of the best medical treatment (BMT) and intervention treatment (INT) in a single-center experience were reported in type B intramural hematoma (IMH). METHODS: From February 2015 to February 2021, a total of 195 consecutive patients with type B IMH were enrolled in the study. The primary end point was mortality, and the secondary end points included clinical and imaging outcomes. The clinical outcomes were aortic-related death, retrograde type A aortic dissection, stent graft-induced new entry tear, endoleak, and reintervention. The imaging outcome was evaluated through the latest follow-up computed tomography angiography, which included aortic rupture, aortic dissection, aortic aneurysm, rapid growth of aortic diameter, newly developed or enlarged penetrating aortic ulcer or ulcer-like projection (ULP) and increased aortic wall thickness. Kaplan-Meier curves were used to assess the association between different treatments. RESULTS: Among the enrolled patients, 115 received BMT, and 80 received INT. There was no significant difference in early (1.7% vs 2.5%; P = 1.00) and midterm all-cause death (8.3% vs 5.2%; P = .42) between the BMT and INT groups. However, patients who underwent INT were at risk of procedure-related complications such as stent graft-induced new entry tear and endoleaks. The INT group was associated with a profound decrease in the risk of ULP, including newly developed ULP (4.3% vs 26.9%; P < .05), ULP enlargement (6.4% vs 31.3%; P < .05), and a lower proportion of high-risk ULP (10.9% vs 45.6%; P < .05). Although there was no significant difference in the incidence of IMH regression between the two groups, the maximum diameter of the descending aorta in patients receiving INT was larger compared with those treated with BMT. CONCLUSIONS: Based on our limited experience, patients with type B IMH treated with BMT or INT shared similar midterm clinical outcome. Patients who underwent INT may have a decreased risk of ULPs, but a higher risk of procedure-related events and patients on BMT should be closely monitored for ULP progression.
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Implantación de Prótesis Vascular , Procedimientos Endovasculares , Hematoma , Humanos , Masculino , Femenino , Hematoma/diagnóstico por imagen , Hematoma/etiología , Hematoma/terapia , Anciano , Persona de Mediana Edad , Estudios Retrospectivos , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/mortalidad , Resultado del Tratamiento , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/mortalidad , Procedimientos Endovasculares/instrumentación , Factores de Riesgo , Factores de Tiempo , Stents , Angiografía por Tomografía Computarizada , Enfermedades de la Aorta/diagnóstico por imagen , Enfermedades de la Aorta/mortalidad , Enfermedades de la Aorta/terapia , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/mortalidad , Disección Aórtica/cirugía , Disección Aórtica/terapia , Medición de Riesgo , Complicaciones Posoperatorias/etiología , Prótesis Vascular , Hematoma Intramural AórticoRESUMEN
Waist-to-height ratio (WtHR) is a validated biomarker of central obesity that appears to be preferable to other body composition measurements in the evaluation of cardiovascular disease. The goal of this research was to explore the connection between WtHR and abdominal aortic calcification (AAC) among adults. On the basis of data from the 2013 to 2014 National Health and Nutrition Examination Survey, multivariate logistic regression, sensitivity analysis, as well as smoothed curve fitting were used to evaluate the connection between WtHR and AAC. Subgroup analyses along with interaction tests were done to see if this link was consistent across populations. Among 3079 participants aged >40 years, there was a negative association between WtHR and ACC. Each 1-unit emergence of WtHR was related to a 2% reduction in the probability of severe AAC in the entirely adjusted model (odds ratioâ =â 0.02, 95% confidence interval: [0.00-0.12]). Participants in the highest WtHR quartile were 39% less likely to acquire severe AAC compared with those in the lowest quartile. (odds ratioâ =â 0.61, 95% confidence interval: [0.37-1.00]). This negative association was more pronounced in the diabetes subgroup. We discovered a reversed U-shaped association between WtHR as well as AAC score utilizing a 2-stage linear regression model, with an intersection point of 0.56. WtHR was negatively associated with AAC among US adults.
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Aorta Abdominal , Encuestas Nutricionales , Calcificación Vascular , Relación Cintura-Estatura , Humanos , Estudios Transversales , Masculino , Aorta Abdominal/diagnóstico por imagen , Aorta Abdominal/patología , Persona de Mediana Edad , Femenino , Calcificación Vascular/epidemiología , Calcificación Vascular/diagnóstico por imagen , Adulto , Enfermedades de la Aorta/epidemiología , Enfermedades de la Aorta/diagnóstico por imagen , Anciano , Factores de Riesgo , Obesidad Abdominal/epidemiologíaRESUMEN
OBJECTIVES: To assess the accuracy of a deep learning-based algorithm for fully automated detection of thoracic aortic calcifications in chest computed tomography (CT) with a focus on the aortic clamping zone. METHODS: We retrospectively included 100 chest CT scans from 91 patients who were examined on second- or third-generation dual-source scanners. Subsamples comprised 47 scans with an electrocardiogram-gated aortic angiography and 53 unenhanced scans. A deep learning model performed aortic landmark detection and aorta segmentation to derive 8 vessel segments. Associated calcifications were detected and their volumes measured using a mean-based density thresholding. Algorithm parameters (calcium cluster size threshold, aortic mask dilatation) were varied to determine optimal performance for the upper ascending aorta that encompasses the aortic clamping zone. A binary visual rating served as a reference. Standard estimates of diagnostic accuracy and inter-rater agreement using Cohen's Kappa were calculated. RESULTS: Thoracic aortic calcifications were observed in 74% of patients with a prevalence of 27-70% by aorta segment. Using different parameter combinations, the algorithm provided binary ratings for all scans and segments. The best performing parameter combination for the presence of calcifications in the aortic clamping zone yielded a sensitivity of 93% and a specificity of 82%, with an area under the receiver operating characteristic curve of 0.874. Using these parameters, the inter-rater agreement ranged from κ 0.66 to 0.92 per segment. CONCLUSIONS: Fully automated segmental detection of thoracic aortic calcifications in chest CT performs with high accuracy. This includes the critical preoperative assessment of the aortic clamping zone.
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Aorta Torácica , Enfermedades de la Aorta , Aprendizaje Profundo , Tomografía Computarizada por Rayos X , Calcificación Vascular , Humanos , Aorta Torácica/diagnóstico por imagen , Estudios Retrospectivos , Femenino , Masculino , Calcificación Vascular/diagnóstico por imagen , Anciano , Persona de Mediana Edad , Tomografía Computarizada por Rayos X/métodos , Enfermedades de la Aorta/diagnóstico por imagen , Algoritmos , Anciano de 80 o más AñosRESUMEN
BACKGROUND: Aortoiliac occlusive disease (AIOD) has traditionally been treated with aortobifemoral bypass (ABF). Unibody endograft (UBE) for AIOD, however, has been increasingly utilized in selected patients. We report outcomes of patients undergoing ABF or UBE for AIOD. METHODS: Patients (2016-2021) undergoing elective ABF or UBE with a unibody device for AIOD were identified at an academic institution. Chi-square and Kaplan-Meier analysis were used to evaluate outcomes by group. RESULTS: One hundred thirty-one patients undergoing UBE or ABF were screened, with 82 included. Twenty-one patients underwent UBE (25.6%) and 61 (74.4%) underwent ABF. UBE patients were older (63.8 vs. 58.2 years; P = 0.01), with a higher prevalence of diabetes (52.4 vs. 19.7%; P = 0.004). Significant differences were seen between UBE and ABF including a shorter surgery length (214 vs. 360 min; P = 0.0001), less blood loss (300 vs. 620 mls; P = 0.001), larger minimum aortic diameter (14.6 vs. 12.6; P = 0.0006), larger common iliac artery (9.5 vs. 7.9; P = 0.005) and lower postoperative ankle-brachial index (0.8 vs. 0.9; P = 0.04). There were no differences in TASC C/D iliac lesions in the UBE than ABF group (66.6% vs. 63.9%; P < 0.82) or Trans-Atlantic Inter-Society Consensus classification femoropopliteal lesions. Unadjusted analysis revealed no significant differences between UBE and ABF for 30-day mortality (0 vs. 1.6%; P = 1), stroke (0 vs. 3.3%; P = 1), or major adverse cardiac events (4.8 vs. 4.9%; P = 1). There were no significant differences in mid-term surgical outcomes over a mean follow-up period of 23.7 months between UBE and ABF groups; specifically endovascular (0 vs. 8.2%; P = 0.3) or open/hybrid reintervention (9.5 vs. 14.8%; P = 0.7) with similar limb occlusion (4.8 vs. 27.8; P = 0.12). Kaplan-Meier estimated primary, primary-assisted, and secondary patency at 36 months were similar with 94%, 100%, and 94% for UBE and 86%, 95%, and 86% for ABF, respectively. Estimated survival at 36 months was 95% for UBE and 97% for ABF (P = 0.8). CONCLUSIONS: Equivalent outcomes were seen between AIOD treated with UBE or ABF in similar patient populations. Mid-term outcomes such as reintervention and patency are similar for UBE and ABF. We still recommend ABF over UBE as a primary modality of treatment in surgically fit patients with greater complexity aortoiliac lesions and with smaller arterial diameters, especially women.
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Enfermedades de la Aorta , Arteriopatías Oclusivas , Implantación de Prótesis Vascular , Prótesis Vascular , Procedimientos Endovasculares , Arteria Femoral , Arteria Ilíaca , Grado de Desobstrucción Vascular , Humanos , Femenino , Masculino , Persona de Mediana Edad , Arteria Ilíaca/cirugía , Arteria Ilíaca/fisiopatología , Arteria Ilíaca/diagnóstico por imagen , Enfermedades de la Aorta/cirugía , Enfermedades de la Aorta/mortalidad , Enfermedades de la Aorta/diagnóstico por imagen , Enfermedades de la Aorta/fisiopatología , Arteriopatías Oclusivas/cirugía , Arteriopatías Oclusivas/fisiopatología , Arteriopatías Oclusivas/mortalidad , Arteriopatías Oclusivas/diagnóstico por imagen , Estudios Retrospectivos , Resultado del Tratamiento , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/instrumentación , Implantación de Prótesis Vascular/mortalidad , Anciano , Factores de Tiempo , Arteria Femoral/cirugía , Arteria Femoral/fisiopatología , Arteria Femoral/diagnóstico por imagen , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/mortalidad , Procedimientos Endovasculares/instrumentación , Factores de Riesgo , Diseño de Prótesis , Complicaciones Posoperatorias/etiología , Medición de RiesgoRESUMEN
BACKGROUND: Careful selection of patients for carotid stenting is necessary. We suggest that patients with a shaggy aorta syndrome may be at higher risk for perioperative embolic complications. METHODS: The study is a retrospective subanalysis of the SIBERIA Trial. We included 72 patients undergoing transfemoral carotid artery stenting. Patients were monitored during the procedures using multifrequency transcranial Doppler with embolus detection and differentiation. Pre- and postprocedural (2 and 30 days) cerebral diffusion-weighted cerebral MRIs were performed. RESULTS: Forty-six patients had shaggy aorta syndrome. Intraoperative embolisms were recorded in 82.6% and 46.1% of patients with and without shaggy aorta syndrome, respectively (P=0.001). New asymptomatic ischemic brain lesions in the postoperative period occurred in 78.3% and in 26.9% of patients with and without shaggy aorta syndrome, respectively (P<0.001). There were no cases of stroke within 2 days in both groups. 3 (6.5%) cases of stroke within 30 days after the procedure were observed only in patients with shaggy aorta syndrome. There were no cases of contralateral stroke. Shaggy aorta syndrome (OR 5.54 [1.83:16.7], P=0.001) and aortic arch ulceration (OR 6.67 [1.19: 37.3], P=0.02) were independently associated with cerebral embolism. Shaggy aorta syndrome (OR 9.77 [3.14-30.37], P<0.001) and aortic arch ulceration (OR 12.9 [2.3: 72.8], P=0.003) were independently associated with ipsilateral new asymptomatic ischemic brain lesions. CONCLUSIONS: Shaggy aorta syndrome and aortic arch ulceration significantly increase the odds of intraoperative embolism and new asymptomatic ischemic brain lesions. Carotid endarterectomy or transcervical carotid stent should be selected in patients with shaggy aorta syndrome.
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Embolia Intracraneal , Stents , Humanos , Embolia Intracraneal/etiología , Embolia Intracraneal/diagnóstico por imagen , Masculino , Femenino , Stents/efectos adversos , Anciano , Estudios Retrospectivos , Persona de Mediana Edad , Factores de Riesgo , Enfermedades de la Aorta/diagnóstico por imagen , Enfermedades de la Aorta/complicaciones , Imagen de Difusión por Resonancia Magnética , Complicaciones Intraoperatorias/epidemiología , Resultado del Tratamiento , Estenosis Carotídea/diagnóstico por imagen , Estenosis Carotídea/complicaciones , Estenosis Carotídea/cirugía , Ultrasonografía Doppler Transcraneal , Síndrome , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/instrumentación , Anciano de 80 o más AñosRESUMEN
BACKGROUND: An ascending aortic thrombus is exceedingly rare. Two instances have been reported in the setting of lung cancer, but only after cisplatin use, which is associated with hypercoagulability. We present the first case of a patient with lung cancer who developed an ascending aortic thrombus without structural risk factors or chemotherapy use. CASE: A 60-year-old white female with significant smoking history presented with several weeks of malaise. A chest computed tomography scan revealed a 2.2-cm right upper lobe mass. As an outpatient, right hilar lymph node immunohistochemistry (IHC) samples via endobronchial ultrasound confirmed thyroid transcription factor-1 adenocarcinoma. After the procedure, the patient endorsed dyspnea and was advised to go to the emergency department. A chest computed tomography angiography identified a new 2.4 × 1.1 × 1.1 cm thrombus within the proximal aortic arch. No pulmonary emboli or intrapulmonary shunts were identified. A hypercoagulable workup was negative. Transthoracic echocardiogram was without left ventricular thrombus, akinesis or hypokinesis, left atrial dilation, or intracardiac shunts. A lower extremity ultrasound was negative for deep vein thrombosis. Given the procedural risk, thrombectomy was deferred. The patient was transitioned to enoxaparin, and a repeat computed tomography for resolution is in process. CONCLUSION: To our knowledge, this is the only case detailing an in situ ascending aortic thrombus in the setting of lung cancer, without structural risk factors, chemotherapy use, or other hypercoagulable comorbidities. Optimal management for an aortic thrombus and malignant disease is less clear. Clinicians should be vigilant for unusual arterial thromboses in patients with high metastatic burden.