A study of the anatomical variations of the carotid arterial tree in Equidae

The internal carotid artery in the horse is of significant veterinary importance due to its intimate relationship with the guttural pouch, and mycotic disease thereof. The relevance of recognising and identifying variations involving the internal carotid artery lies in the fact that surgical occlusion of the artery is the treatment of choice for guttural pouch mycosis. However, occlusion could be hampered when there is doubt about the anatomy of this vessel and its variation. Conventional angiography and automatic rotational angiographic techniques were used to study the anatomy of the carotid trifurcation and the internal carotid artery on cadavers of three species included in the genus Equus; 50 horses, 26 donkeys and one zebra. Following angiography, arterial latex casting was performed on the horse and donkey specimens with subsequent dissection to harvest the hardened arterial casts. Rotational angiography with 3-dimensional image reconstruction represent a major advantage in the angiographic diagnosis of carotid and cerebral vascular variation compared to conventional angiography. This technique generated superior angiographic images of the carotid and cerebral vascular system of horses, donkey and zebra. In the horse, five variations of the internal carotid artery were identified as follows: [1] the internal carotid artery and occipital artery arising as a common trunk, [2] an aberrant branch of the internal carotid artery that unites with the basilar artery, [3] an aberrant branch of the internal carotid artery that does not unite with the basilar artery, [4] aberrant branch of the internal carotid artery that gives rise to several satellite branches, [5] aberrant branch of the internal carotid artery that has a satellite branch connected to the caudal branch of the ipsilateral occipital artery. Variations of the carotid arterial tree in donkeys were identified as follow: [1] the internal carotid and occipital arteries shared a common trunk, [2] the linguofacial trunk originated from the common carotid artery causing the common carotid artery to terminate as four branches, [3] a short external carotid artery before giving rise to the linguofacial trunk, mimicking the appearance of the common carotid artery terminating into four branches, [4] the internal carotid artery originating far more caudal from the common carotid artery termination. The carotid arterial anatomy of the one zebra studied here showed no discrepancy to the accepted common anatomical pattern of this structure. Aneurysm formation was not identified in any of the specimens

Dynamic Analysis of X-ray Angiography for Image-Guided Coronary Interventions

Percutaneous coronary intervention (PCI) is a minimally-invasive procedure for treating patients with coronary artery disease. PCI is typically performed with image guidance using X-ray angiograms (XA) in which coronary arter

Hemodynamic Measurement Using Four-Dimensional Phase-Contrast MRI: Quantification of Hemodynamic Parameters and Clinical Applications

Recent improvements have been made to the use of time-resolved, three-dimensional phase-contrast (PC) magnetic resonance imaging (MRI), which is also named four-dimensional (4D) PC-MRI or 4D flow MRI, in the investigation of spatial and temporal variations in hemodynamic features in cardiovascular blood flow. The present article reviews the principle and analytical procedures of 4D PC-MRI. Various fluid dynamic biomarkers for possible clinical usage are also described, including wall shear stress, turbulent kinetic energy, and relative pressure. Lastly, this article provides an overview of the clinical applications of 4D PC-MRI in various cardiovascular regions.113Ysciescopuskc

New perspectives in percutaneous coronary intervention based on an integrated approach of imaging and physiology

In this thesis we investigated: a) the prognostic role of FFR in functional evaluation of epicardial stenosis in different anatomical and clinical settings of patients with stable CAD, heart valve disease and LVD; b) the role of IMR, CFR and absolute coronary flow and microvascular resistances assessment with a new dedicated thermodilution catheter; c) the diagnostic performance of two new angiography-derived FFR technologies for a quantitative and functional assessment of CAD; d) the impact of antiplatelet agents and BVS Absorb™ implantantion on procedure-related microvascular impairment, platelet activation and the related myonecrosis; e) the safety and feasibility of new 2-stent bifurcation techniques and the clinical outcome of known bifurcations techniques. We believe that many answers have been provided by our extensive translational research. FFR remains the milestone in functional assessment of the ischemic burden related to coronary stenoses. Our findings corroborate the strong clinical outcome background of FFR, supporting FFR-guided revascularization strategies above angio-based decision making, and therefore strongly discouraging any purely anatomy guided revascularization attempts in different clinical and anatomical settings. Absolute coronary blood flow (Q) and microvascular resistance (R) can be safely and reproducibly measured with continuous thermodilution, opening new opportunities for the study of the coronary microcirculation. FFRangio and QFR provide both a comprehensive physiological assessment of the entire coronary tree within few minutes, enabling online FFR measurement during the angiographic procedure. This, in turn, may facilitate the adoption of FFR-based clinical decision making regarding coronary revascularization. Both prasugrel and BVS Abosrb™ have proven a beneficial acute effect on peri-procedural coronary microvascular function and platelet activation. Although BVS Absorb™ did not live up to its promise because of the higher events in the mid-term due to greater scaffold thrombosis, our findings are at least reassuring on the acute impact of these devices on the microcirculation. Lastly in PCI of bifurcation lesions, our feasibility results of in vitro tests, offer new solutions for both complex anatomy requiring 2-stent-technique and bailout technique in case of failure of the most consolidated provisional T-stenting

CMR Assessment of endothelial damage and angiogenesis in porcine coronary arteries using gadofosveset

<p>Abstract</p> <p>Background</p> <p>Endothelial damage and angiogenesis are essential for atherosclerotic plaque development and destabilization. We sought to examine whether contrast enhanced cardiovascular magnetic resonance (CMR) using gadofosveset could show endothelial damage and neovessel formation in balloon injured porcine coronary arteries.</p> <p>Methods and Results</p> <p>Data were obtained from seven pigs that all underwent balloon injury of the left anterior descending coronary artery (LAD) to induce endothelial damage and angiogenesis. Between one - 12 days (average four) after balloon injury, in vivo and ex vivo T1-weighted coronary CMR was performed after intravenous injection of gadofosveset. Post contrast, CMR showed contrast enhancement of the coronary arteries with a selective and time-dependent average expansion of the injured LAD segment area of 45% (p = 0.04; CI₉₅= [15%-75%]), indicating local extravasation of gadofosveset. Vascular and perivascular extravasation of albumin (marker of endothelial leakiness) and gadofosveset was demonstrated with agreement between Evans blue staining and ex vivo CMR contrast enhancement (p = 0.026). Coronary MRI contrast enhancement and local microvessel density determined by microscopic examination correlated (ρ = 0.82, p < 0.001).</p> <p>Conclusion</p> <p>Contrast enhanced coronary CMR with gadofosveset can detect experimentally induced endothelial damage and angiogenesis in the porcine coronary artery wall.</p

Experimental validation and clinical comparison of quantitative coronary analysis systems

The kernel topic of this thesis is the validation of QCA systems by a new experimental approach involving the percutaneous insertion of coronary stenosis phantoms in swine coronary arteries. The reliability of digital as well as cinefilm-based QCA systems has been compared on the basis of this experimental approach using different calibration techniques as well as on the basis of more traditional in vitro experiments and the practical value of various quantitative geometric parameters is discussed. In a comparative analysis with geometric coronary measurements, currently available software packages for videodensitometric analysis have been validated using experimental and clinical data and the potential role of videodensitometry for intracoronary volume estimation has been evaluated. Furthermore, on-line and off-line techniques for estimation of coronary flow reserve have been compared. Finally, the assessment of coronary artery luminal dimensions by intracoronary ultrasound has been compared with corresponding measurements obtained by quantitative angiography and basic m