Deficiency of mast cells in coronary artery endarterectomy of male patients with type 2 diabetes

<p>Abstract</p> <p>Background</p> <p>Type 2 diabetes is an important risk factor for the development of coronary artery disease (CAD). Focal or diffuse inflammation is often present in the vessels of patients with CAD. Mast cells are frequently present in the plaques as well as in the inflammatory infiltrates in the atherosclerotic vessel wall. In the study we wanted to examine whether there are differences in the morphology, number and distribution of mast cells and in their ability to modify the atherosclerotic process in coronary arteries (CA) in the diabetic <it>vs</it>. the hypertensive population of patients with CAD.</p> <p>Methods</p> <p>Coronary artery endarterectomy specimens were obtained from patients with diabetes or hypertension as the only risk factor for CAD. The specimens were stained with haematoxylin-eosin and Sulphated Alcian Blue for mast cells and with immunofluorescent methods for fibrinogen-fibrin and IgG deposits in the vessel wall. Both morphological and stereological assessments were conducted for mast cells and mononuclear cell infiltrates.</p> <p>Results</p> <p>The histological analysis of the vessel wall of diabetic patients in comparison with hypertensive patients showed a damaged endothelial cells layer and deposits of fibrin-fibrinogen and IgG in the tunica intima and media. The stereological count revealed a diminished numerical density of mast cells and a significantly higher volume density of the mononuclear cells. Mast cells displayed cytoplasmic vacuolization, extracellular extrusion of granule and pyknotic nuclei.</p> <p>Conclusion</p> <p>This preliminary study suggests that the impaired mast cells might be the reason for more extensive inflammatory and immunologic atherosclerotic changes in the CA vessel wall of CAD patients with type 2 diabetes.</p> <p>Trial registration</p> <p>134/88;C3-0564-381-92</p

Immune cells and vasa vasorum in the tunica media of atherosclerotic coronary arteries

In coronary artery disease (CAD), the disruption of the tunica media immune privilege manifests as increased leukocyte infiltration and the formation of vasa vasorum. We aimed to characterize the immune privilege status of the tunica media in human coronary arteries (CAs) with atherosclerotic plaques, by comparing the abundance and composition of immune-cell infiltrates within the individual arterial-wall layers, and by evaluating vasa vasorum neovascularization of the tunica media. The tissue samples were obtained from 36 symptomatic patients with diffuse CAD (aged 60–72 years) who underwent coronary endarterectomy. T and B cells, macrophages and endothelial cells in the CAs were detected by immunohistochemistry. Morphological analysis of CAs showed significant atherosclerotic changes in all specimens. In the media, we observed damage and loss of smooth muscle cells, destruction of the extracellular matrix architecture, and fibrosis. There were 43.3% of immune cells in the intima, 50% in the adventitia, and 6.7% in the media. In the media, 51.1% of the immune cells were T cells (p ˂ 0.001 compared to B cells and macrophages; ANOVA, Scheffe post hoc analysis), 23.5% were B cells, and 25.4% were macrophages. The number of vasa vasorum in the media was 1 in 38.9% of CAs, 2–3 in 36.1%, and ≥4 in 25% of CAs. Our results indicate that, in atherosclerotic CAs, the immune privilege of the media is disrupted by the infiltration of T and B cells, macrophages, and the presence of vasa vasorum

Patent Foramen Ovale-associated Stroke and COVID-19 Vaccination

Background: COVID-19 infection has been associated with paradoxical thromboembolism through a patent foramen ovale (PFO) and ischaemic stroke. Such events have not been reported after COVID-19 vaccination. The aim of the present study was to investigate PFO-associated stroke during the mass COVID-19 vaccination in Slovenia. Methods: This prospective study, conducted between 26 December 2020 and 31 March 2022, enrolled consecutive patients (≥18 years) with PFO-associated stroke referred for a percutaneous closure to a single interventional facility in Slovenia. Results: A total of 953,546 people aged between 18 and 70 years received at least one dose of a COVID-19 vaccine approved by the European Medicines Agency. Of the 28 patients presenting with PFO-associated stroke, 12 patients (42.9%) were vaccinated prior to the event, of whom nine were women and three were men, aged between 21 and 70 years. Stroke occurred within 35 days after vaccination in six patients (50%). Clinical presentation included motor dysphasia, paresis, vertigo, ataxia, paraesthesia, headache, diplopia and hemianopia. At hospital discharge, 11 patients (91.6%) had at least one residual ischaemic lesion. Conclusion: A temporal coincidence of COVID-19 vaccination and PFO-associated stroke has been described. A potential cause–effect relationship may only be hypothesised

Śródkanałowe zamknięcie przetrwałego otworu owalnego za pomocą stentu FlatStent EFTM

Background: Devices for percutaneous closure of patent foramen ovale (PFO) are traditionally based on two opposing discs, leaving significant surface areas exposed in the left and right atrium. The FlatStent EF™ PFO Closure System (Coherex Inc., Salt Lake City, USA) represents a major departure from these devices because it is designed to focus primarily on the PFO tunnel, leaving minimal foreign material behind. Aim: To investigate the patient selection, effectiveness, and safety of in-tunnel closure with a FlatStent EF™ in patients with PFO of ≥ 4 mm tunnel length and &lt; 12 mm diameter at preprocedural transoesophageal echocardiography (TEE). Results: Among 46 consecutive patients undergoing PFO closure, a FlatStent EF™ could be implanted and resulted in initial successful closure (&lt; 5 bubbles during Valsalva manoeuvre) in 21 (46%) patients. TEE at 162 ± 40 and 317 ± 162 days after implantation demonstrated functional closure in 90% and 95% of cases, respectively. No device or air embolisation, pericardial effusion, or thrombus formation was documented. Small in-tunnel peri-device colour Doppler left to right flow was documented in 10% and 2–6 mm protrusion of FlatStent EF™ along right atrial septum without any residual flow/bubble shunting in 14%. Patients with suboptimal closure (&gt; 5 bubbles during Valsalva manoeuvre and/or in-tunnel colour flow) had shorter tunnel on preprocedural TEE (5.3 ± 1.5 vs. 10.8 ± 3.5 mm; p = 0.003). There was no difference in TEE diameter (1.8 ± 0.5 vs. 2.0 ± 0.5 mm; p = 0.38) and stretched diameter by sizing balloon (6.3 ± 2.5 vs. 6.3 ± 1.0 mm; p = 1.00). Conclusions: In-tunnel PFO closure with a FlatStent EF™ represents an effective and safe option only in carefully selected patients with long tunnel (&gt; 4 mm) regardless of the diameter if it is &lt; 12 mm. These criteria are fulfilled in &lt; 50% of consecutive candidates for PFO closure. The new phenomenon of in-tunnel peri-device flow and FlatStent EF™ protrusion along the right atrial septum were documented during systematic TEE follow up.Wstęp: Urządzenia do przezskórnego zamknięcia przetrwałego otworu owalnego (PFO) tradycyjnie są zbudowane z dwóch przeciwstawnych dysków o stosunkowo dużej powierzchni, które zakłada się do lewego i prawego przedsionka. System stentu do zamykania PFO FlatStent EF™ (Coherex Inc., Salt Lake City, USA) stanowi zdecydowane odejście od tego typu urządzeń, ponieważ mieści się on głównie w kanale PFO, a ilość obcego materiału znajdująca się poza kanałem jest minimalna. Cel: Badanie przeprowadzono w celu oceny doboru pacjentów, skuteczności i bezpieczeństwa śródkanałowego zamknięcia PFO przy użyciu stentu FlatStent EF™ u chorych, u których długość kanału, określona na podstawie przeprowadzonej przed zabiegiem echokardiografii przezprzełykowej (TEE), wynosiła ≥ 4 mm, a średnica &lt; 12 mm. Wyniki: U 21 (46%) spośród 46 kolejnych pacjentów poddanych zabiegowi zamknięcia PFO było możliwe wszczepienie stentu FlatStent EF™; u tych chorych uzyskano wstępne skuteczne zamknięcie PFO (&lt; 5 pęcherzyków kontrastu podczas próby Valsalvy). Wyniki TEE wykonanego po 162 ± 40 i 317 ± 162 dniach po wszczepieniu stentu wykazały czynnościowe zamknięcie PFO u odpowiednio 90% i 95% chorych. Nie stwierdzono zatoru powietrznego ani spowodowanego urządzeniem wysięku osierdziowego, ani też utworzenia się skrzepliny. W badaniu techniką kolorowego doplera u 10% chorych wykryto niewielki śródkanałowy przeciek lewo-prawy wokół urządzenia, a u 14% stwierdzono wysunięcie stentu FlatStent EF™ wzdłuż przegrody prawego przedsionka o 2–6 mm, bez cech przepływu resztkowego/pęcherzyków kontrastu. U chorych z suboptymalnym zamknięciem (&gt; 5 pęcherzyków kontrastu podczas próby Valsalvy i/lub przepływ śródkanałowy w badaniu metodą kolorowego doplera) długość tunelu określona w TEE przed zabiegiem była mniejsza (5,3 ± 1,5 vs. 10,8 ± 3,5 mm; p = 0,003). Nie stwierdzono różnicy pod względem średnicy kanału określonej w TEE (1,8 ± 0,5 vs. 2,0 ± 0,5 mm; p = 0,38) ani średnicy rozciągniętego otworu zmierzonej za pomocą balonu wymiarującego (6,3 ± 2,5 vs. 6,3 ± 1,0 mm; p = 1,00). Wnioski: Śródkanałowe zamknięcie PFO przy użyciu stentu FlatStent EF™ jest skuteczną i bezpieczną metodą zarezerwowaną dla starannie dobranych pacjentów z długim kanałem (&gt; 4 mm) niezależnie od średnicy kanału, jeśli mieści się ona w zakresie &lt; 12 mm. Kryteria te spełniało &lt; 50% kolejnych pacjentów kwalifikowanych do zamknięcia PFO. W trakcie obserwacji po zabiegu u chorych systematycznie wykonywano TEE, w których stwierdzono nowe zjawisko — śródkanałowy przeciek wokół urządzenia i wysuwanie się stentu FlatStent EF™ wzdłuż przegrody prawego przedsionka