Coexistence of posterior cerebral circulation anatomical variations andbasilar artery aneurysms : case-control study

Background: The anatomy of arteries supplying blood to the brain often varies among the population. It applies particularly to posterior cerebral circulation. The impact of its anatomy variabilities on the formation of intracranial aneurysms has not been determined yet. The aim was to find out if posterior cerebral circulation anatomy variations coexist with basilar artery aneurysms (BAAs). We retrospectively analyzed 27 patients with BAA and a group of 30 patients matched by gender and age but without BAA. In both groups together most (66.67%) of patients were female and the average age was 59.75 ± 10.91. All of the patients had Computed Tomography performed. We assessed the occurrence of BAA, basilar artery (BA) diameter, vertebral artery (VA) diameter, posterior cerebral artery (PCA) diameter, and if patients had hypoplastic VA or PCA. Results: The presence of right VA hypoplasia significantly increased the risk of BAA occurrence (48.15% vs. 16.67%; p = 0.011). The occurrence of hypoplastic VA on either side was significantly associated with the risk of BAA formation (59.26% vs. 26.67%; p = 0.013). Patients with BAA had slightly larger left PCA diameter 1cm after division (1.96 ± 0.51 vs. 1.64 ± 0.42; p = 0.014) in comparison to those without BAA. Additionally, hypoplastic right PCA occurred more often in patients with BAA (22.22% vs. 0%; p = 0.022). Conclusions: We can conclude that the anatomy of PCA and VA affects the occurrence of BAA. Hypoplastic VA, the presence of wider left PCA and hypoplastic right PCA may be factors that coexist with BAA occurrence

Subcostal echocardiographic assessment of tricuspid annular kick (SEATAK) — a novel independent predictor of 30-day mortality in patients with acute pulmonary embolism

BACKGROUND: The most commonly used parameter of right ventricular (RV) systolic function — tricuspid annular plane systolic excursion (TAPSE) is unavailable in some patients. Subcostal echocardiographic assessment of tricuspid annular kick (SEATAK) has been proposed as its alternative. AIM: The aim of the study was to assess the feasibility of SEATAK use in patients with acute pulmonary embolism (PE) and its value in prognosis after PE. METHODS: The observational study included 164 consecutive patients (45.7% men; average age, 70 years) with high clinical probability of PE referred for computed tomography pulmonary angiography. RESULTS: SEATAK was unavailable due to inadequate quality of echocardiograph in 2.8% of patients, whereas TAPSE in 4.9%, both parameters only in 0.6%. SEATAK and TAPSE values did not differ between groups of patients with (n = 82) and without PE (n = 82). In the whole study SEATAK correlated positively with TAPSE (r = 0.71; 95% confidence interval [CI], 0.62–0.78; P <0.001), fractional area change of RV, left ventricular ejection fraction and peak systolic tricuspid annular velocity assessed with tissue Doppler imaging. There were only 3 echocardiographic predictors of 30-day all-cause mortality (n = 10) in patients with PE: SEATAK, pulmonary acceleration time and 60/60 sign. SEATAK predicted 30-day all-cause mortality with AUC (area under the curve) 0.726 (95% CI, 0.594–0.858; P = 0.01) and 30-day PE-related mortality (n = 4) with AUC, 0.772 (95% CI, 0.506–0.998; P = 0.03). CONCLUSIONS: SEATAK is a promising feasible echocardiographic parameter reflecting RV systolic function and might be an accurate alternative to TAPSE. Moreover, SEATAK could be an independent predictor of all-cause and PE-related 30-day mortality in patients with acute PE