Gianluca Rigatelli, Marco Zuin, Alan Fong, Truyen TTT Tai and Thach Nguyen
. Noticeably, higher WSS within the ascending aorta have been suspected to be involved in aortic aneurysm and dissection. [ 4 , 5 ] The aim of our study is to investigate, by means of computation fluid dynamic analysis (CFD), the presence and potential impact of turbulences induced by ostial LM stenting, not only in the LM but also within the ascending aorta and arch.
Construction of the virtual model
For the computational domain analysis, we reconstructed the ascending aorticarch from the plane of the aortic valve to the left subclavian artery. Both
Nerijus Misonis, Darius Palionis, Algirdas Tamošiūnas, Vaidotas Zabulis, Kristina Ryliškienė and Dalius Jatužis
Aim: The aim of the paper is to evaluate the appearance of the new early ischemic lesions in the brain after carotid angioplasty and stenting on diffusion-weighted magnetic resonance imaging, and their relationship with clinical and procedural factors.
Methods: Carotid artery stenting (CAS) procedures performed by a single interventional cardiologist in years November 2006 to January 2013 were evaluated retrospectively. In total, 227 procedures for 211 patients (mean age 69.8 ± 8.5 years) were performed, from which 171 (75.3%) for male and 56 (24.7%) for female patients. Seventy-two (34.1%) patients had symptomatic stenosis of carotid artery. The following protection systems to avoid the distal microembolism were used during the CAS: (1) Filters: FilterWire EZ (Boston Scientific Corporation); Emboshield NAV (Abbott Vascular); SpideRX (EV3); Defender (Medtronic); FiberNet Filter (Invatec-Medtronic); (2) Occlusion MoMa Baloon System (Invatec-Medtronic). Acute ischemic damages of the brain before and after CAS procedure were diagnosed using magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) sequences. Sixty-five (30.8%) patients underwent MRI test. Exact and asymptomatic χ2 criteria were applied for testing the hypothesis of inter-dependency of the symptoms.
Results: Forty-six (70.8%) patients had new ischemic foci in the brain on MRI DWI after CAS procedures. Among those patients, focal damage of the brain was diagnosed in 36 (78.3%) cases; linear damage of the brain - in 9 (19.6%) patients; ipsilateral damage of the brain - in 37 (80.4%) patients; bilateral damage of the brain - in 16 (34.8%) patients, 38 (82.6%) patients were diagnosed with forebrain damage; 4 (8.7%) patients were diagnosed with damage of brainstem; 5 (10.9%) patients were diagnosed with cerebellum damage. Clinical symptoms of brain damage were diagnosed only for 2 (4.3%) patients. Focal damage of the brain was significantly less frequent only for aortic arch type 1, if compared with aortic arch type 2 and 3: 64.3%, 93.3% and 100.0%, respectively (p < 0.05). Focal damage of the brain occurred least in patients (28.6%) with Emboshield NAV protection type, if compared to other types of protection (71.4-100.0%). Linear >10mmbrain damage was less frequent when using FilterWire EZ, Emboshield NAV and SpideRX protection type. Ipsilateral ischemic brain damage also occurred less frequent when using Emboshield NAV protection type; bilateral damage occurred less frequent when using FilterWire EZ, Emboshield NAV and SpideRX protection type. Ischemic forebrain damage was also diagnosed less often in patients for whom protection type FilterWire EZ and Emboshield NAV was applied.
Conclusions: Most frequent findings by MRI after CAS procedures were focal, ipsilateral and forebrain damage (about 80%), but less than 5% patients had clinical symptoms. In the case of aorta arch type 1 focal ischemic damage of the brain was significantly less frequent, then in aortic arch type 2 and 3. The localization and extent of brain damage was associated with the type of protection systems that have been used.
Simina-Elena Rusu, Daniela Toma, Cristina Blesneac, Laura Matei, Claudiu Ghiragosian and Rodica Togănel
period: a comparative study with the adult animal. Pediatr Res. 1979;13;910-915.
13. Thornburg KI, Morton MJ. Filling and arterial pressure as determinants of RV stroke volume in the sheep fetus. Am J Physiol. 1983;244:H656.
14. Morrow Wr, Huhta JC, Murphy DJ Jr, McNamara DG. Quantitative morphology of the aorticarch in neonatal coarctation. J AM Coll Cardiol. 1986;8:616-620.
Hisashi Sawada, Jeff Z. Chen, Bradley C. Wright, Mary B. Sheppard, Hong S. Lu and Alan Daugherty
thoracic aorta is composed of four distinct regions: aortic root, ascending aorta, aorticarch, and descending portion. [ 2 ] Of note, 60% of TAAs impact the aortic root and/or the ascending aorta in human. [ 3 ] For example, TAAs in Marfan syndrome and Ehlers-Danlos syndrome occur most often in the aortic root. [ 4 , 5 , 6 ] TAAs in Loeys-Dietz syndrome and Turner syndrome preferentially form in both the aortic root and the ascending aorta. [ 7 , 8 , 9 , 10 ] Aortic aneurysms in patients with bicuspid aortic valve are most commonly reported in the ascending
aging of the population, the rise in the number of smokers, the introduction of screening programs, and improved diagnostic tools. The disorder is more common in men than in women, with prevalence rates estimated at 1.3–8.9% in men and 1.0–2.2% in women. [ 1 ] However, thoracic aortic aneurysms (TAAs) have an estimated incidence of at least 5-10 per 100,000 person-years. [ 2 ] According to location, TAAs are classified into aortic root or ascending aortic aneurysms, which are most common (≈60%), followed by aneurysms of the descending aorta (≈35%) and aorticarch