Assessment of lateral costal artery with CT angiography: determination of prevalence and vessel length in the general population and its potential impact for coronary artery bypass grafting

Objectives Standard treatment for severe coronary artery disease (CAD) is coronary artery bypass grafting (CABG). An underreported branch of the internal mammary artery, the lateral costal artery (LCA), can cause a steal phenomenon after CABG, resulting in angina. The aim of this study was to determine the prevalence and length of LCA based on CT angiography (CTA). Methods This retrospective study included adult patients undergoing a thoracic CTA between January 2016 and August 2018. Exclusion criteria were prior CABG, insufficient clinical information, or inadequate image quality. Two blinded, independent readers reviewed all studies for the prevalence of the LCA. Positive cases were reviewed by two readers (R1/R2) for side distribution and vessel length, measured in intercostal spaces (ICS). Study indication, aortic size, and coronary calcification were noted. Results LCA was present in up to 42/389 (11%) of studies (60.3 +/- 16.7 years, 30 males). The LCA was most commonly unilateral (n= 23, 55%). Median vessel length was 2 ICS (IQR 0; 3). Logistic regression was not significant in vessel distribution for sex (OR 0.6, 95% CI 0.28-1.15;p= 0.11). Inter-observer agreement in detecting LCA was substantial (kappa 0.71, 95% CI 0.59-0.83) and excellent for side/length distribution (kappa 0.94, 95% CI 0.82-1.0; ICC 0.96, 95% CI 0.93-0.98). Conclusion The LCA is uncommon and most often unilateral and extends the third rib. Radiologists should be aware of this vessel and its potential role in angina after CABG, particularly when large

Transitions in regional economic development

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Global reversal, regional revival?

Regional Studies celebrates its 50th anniversary with this special issue. This introductory article reflects back on developments since the journal was started and offers signposts for urban and regional research looking ahead. It outlines the changing global context for regional studies and identifies some of the ways in which the need for regional research is enhanced by the extraordinary challenges currently confronting the world. It also introduces important themes from the recent history of the journal that are likely to feature in future. This is obviously a highly selective exercise, given the considerable breadth and depth of regional research over the years

Regions in a time of pandemic

Contains fulltext : 228247.pdf (publisher's version ) (Closed access)11 p

Regions in a time of pandemic [Editorial]

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Rethinking regions in turbulent times [editorial]

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