Krónikus aortadissectio talaján kialakult thoracoabdominalis aneurysma endovascularis kezelése fenesztrált sztentgrafttal = Fenestrated endovascular repair of a thoracoabdominal aortic aneurysm in chronic dissection

Thoracoabdominal aortic aneurysms developing in the chronic phase of an aortic dissection require multidisciplinary approach, experienced operators and advanced technology. The mortality and morbidity rate of these multistage operations were reduced with the latest technical achievements in endovascular repair, but they are still significant. Fenestrated endovascular aortic repair, an alternative of thoracoabdominal open repair, is associated with less mortal-ity and morbidity, shorter hospital stay. Using fenestrated devices in aortic dissection is usually technically demanding due to the dissection membrane. We report the case of a 56-year-old woman, who underwent ascending aortic repair due to type A aortic dissection. During the follow-up, a large thoracoabdominal aneurysm developed involving also the arch. We performed a three-stage operation starting with the open repair of the aortic arch using a 'frozen ele-phant trunk' device followed by a thoracic endovascular aortic repair of the descending aorta. The final stage was a fenestrated endovascular aortic repair, which is the first use of this technique in aortic dissection in Hungary

The impact of increasing saline flush volume to reduce the amount of residual air in the delivery system of aortic prostheses—a randomized controlled trial

BackgroundAir embolism is a known risk during thoracic endovascular aortic repair (TEVAR) and is associated with an incomplete deairing of the delivery system despite the saline lavage recommended by the instructions for use (IFU). As the delivery systems are identical and residual air remains frequently in the abdominal aortic aneurysm sac, endovascular aortic repair (EVAR) can be used to examine the effectiveness of deairing maneuvers. We aimed to evaluate whether increasing the flush volume can result in a more complete deairing.MethodsPatients undergoing EVAR were randomly assigned according to flushing volume (Group A, 1× IFU; Group B, 4× IFU). The Terumo Aortic Anaconda and Treo and Cook Zenith Alpha Abdominal stent grafts were randomly implanted in equal distribution (10-10-10). The quantity of air trapped in the aneurysm sac was measured using a pre-discharge computed tomography angiography (CTA). Thirty patients were enrolled and equally distributed between the two groups, with no differences observed in any demographic or anatomical factors.ResultsThe presence of air was less frequent in Group A compared to that in Group B [7 (47%) vs. 13 (87%), p = .02], and the air volume was less in Group A compared to that in Group B (103.5 ± 210.4 vs. 175.5 ± 175.0 mm3, p = .04). Additionally, the volume of trapped air was higher with the Anaconda graft type (p = .025).DiscussionThese findings suggest that increased flushing volume is associated with a higher amount of trapped air; thus, following the IFU might be associated with a reduced risk of air embolization. Furthermore, significant differences were identified between devices in terms of the amount of trapped air. Clinical trial registration[NCT04909190], [ClinicalTrials.gov]

A fotonszámláló detektoros CT működési alapelve, előnyei és jelentősége a klinikai gyakorlatban = Photoncounting-detector CT: Basic principles, advantages and implications in clinical practice

Az elmúlt évtizedben fizikai és preklinikai vizsgálatokkal igazolták az alapjaiban új típusú, fotonszámláló komputertomográfiás (CT) detektor kiváló képalkotási tulajdonságait, míg napjainkban a páréves klinikai felhasználás egyre szélesebb körű tapasztalatait veszik számba. A klinikai gyakorlatban elterjedt, hagyományos CT-berendezésekben energiaintegráló detektorok (EID) találhatók, melyek indirekt konverziós technológiával alakítják át a röntgenfotonok energiáját elektromos jellé. Ezzel ellentétben a fotonszámláló CT detektorai (PCD) közvetlenül és magasabb hatásfokkal képesek elektromos jellé alakítani a röntgenfotonok energiáját, megszámlálni az egyes röntgenfotonok által létrehozott töltéseket és mérni azok energiaszintjét. Az új PCD-technológia számos előnyt nyújt a hagyományos EID-technológiával összevetve: egyrészt kisebb sugárterhelés mellett jobb térbeli felbontású, kedvezőbb jel/zaj arányú, kevesebb sugárkeményedési („beam-hardening”) műterméket tartalmazó és alacsonyabb elektronikus zajjal terhelt CT-képeket hoz létre, másrészt lehetővé teszi a spektrális képalkotást, valamint csökkentett dózisú kontrasztanyag alkalmazására is lehetőséget ad. Összefoglaló közleményünk a PCD-CT műszaki és fizikai alapelveit ismerteti, valamint áttekintést nyújt annak előnyeiről és a klinikai gyakorlatban való felhasználásáról. | Over the last decade, an esentially new type of computed tomography (CT) detector, namely the photoncounting detector has demonstrated its superior capabilities over traditional CT detectors in both physical and preclinical evaluations, while is now at the stage of early clinical experiences. Conventional CT scanners available today for routine clinical practice use energy integrated detectors (EID) which rely on indirect conversion technology. In contrary, the newly-introduced photon-counting detectors (PCD) utilize a direct conversion method allowing to count the number of x-ray photons and carry detailed information about the energy level of each individual x-ray photon. Due to the fundamental changes in the physical mechanisms responsible for photon detection and signal creation, PCDs have several benefits over traditional CT detectors. In comparison to current CT technology, PCDCT can produce better spatial resolution, reduced electronic noise with a higher contrast-to-noise ratio, reduced beam-hardening and metal artifacts. Furthermore, from the spectral information, this new technology is capable to reconstruct virtual monoenergetic images and optimize iv. contrast agent dose. In our current review article, technical principles and physics of PCDs and, in addition, early clinical experiences with their applications are summarized

Különböző cardiovascularis rizikóbecslő pontrendszereken, a pulzushullám-terjedési sebességen és a coronaria-kalcium pontszámon alapuló artériás életkor számítási módszereinek összehasonlítása = Comparison of different cardiovascular risk score, pulse wave velocity and coronary artery calcium score- based methods for vascular age calculation

Bevezetés: Az artériás (vascularis) életkor meghatározása segíthet a betegeknek a prevenciós stratégiák fontosságának megértésében. Habár számítására több módszer is létezik, ezek összehasonlításáról jelenleg nem áll rendelkezésre adat. Célkitűzés: Kutatásaink célja, hogy meghatározzuk az artériás életkort a Framingham Risk Score (FRS), a Systematic COronary Risk Evaluation Score (SCORE), a carotis-femoralis pulzushullám-terjedési sebesség (PWV), illetve a coronaria-kalcium pontszám (CACS) mérése alapján. Módszerek: Első vizsgálatunkba szív- és érrendszeri szűrőprogramon részt vevő egyének kerültek bevonásra, míg második kutatásunk betegcsoportját kis és közepes rizikójú, mellkasi panaszos betegek képezték. A PWV-t tonometriás módszerrel határoztuk meg, míg az artériás életkor meghatározása az FRS, SCORE, valamint a CACS rizikóbecslő pontszámok segítségével történt. Az artériás, illetve kronológiai életkor különbsége alapján azonosítottuk az emelkedett artériás korú egyéneket (PWV+, FRS+, SCORE+, CACS+). Eredmények: Az első vizsgálatba bevont 172 páciens esetében a PWV+ betegek közül 58 (84%) volt FRS+ is, és ez az arány a SCORE+ betegek esetében is magas volt (47/55, 85,4%). A PWV+ és a SCORE+ alanyok között azonban csak mérsékelt átfedés volt, a SCORE+ betegek közül mindössze 17 (30,9%) volt PWV+ is. A második vizsgálat 241 páciense esetén az FRS- és SCORE-alapú biológiai életkor erős korrelációt mutatott (r=0,84, p<0,001), míg a CACS alapján számított életkor mérsékelten korrelált az FRS és a SCORE alapján kalkulálttal (r=0,50 és r=0,52, mindkettő p<0,001). Következtetés: A különböző módszerrel meghatározott artériás életkorok között tapasztalt eltérések az egyes artériáséletkor-számítási módszerek további részletes összehasonlítását kívánják meg prospektív körülmények között. = Background: The calculation of vascular age can help patients understand the importance of preventive strategies. However, multiple methods are available to calculate vascular age and no comparison data is available yet. Aim: Our aim was to evaluate vascular age based on the Framingham Risk Score (FRS), the Systematic COronary Risk Evaluation (SCORE), carotid-femoral pulse wave velocity (PWV) and coronary artery calcium score (CACS). Methods: Individuals participating in a cardiovascular screening program were included in our first study, whereas the population of our second study consisted of low and intermediate risk patients with stable chest pain. PWV was measured by tonometry, while vascular age was defined based on FRS, SCORE and CACS risk scores. Individuals with elevated vascular age (PWV+, FRS+, SCORE+, CACS+) were identified based on the observed differences between vascular and the respective chronological age. Results: In our first study, 172 patients were involved. Overall, 58 (84%) of the PWV+ subjects were also FRS+, and this proportion was high in case of SCORE+ patients as well (47/55, 85.4%). However, only moderate overlap was found between PWV+ and SCORE+ subjects as 17 (30.9%) of SCORE+ patients were also PWV+. In our second substudy involving 241 patients, FRS- and SCORE-derived biological age showed strong correlation (r=0.84, p<0.001), while vascular age based on CACS moderately correlated with FRS and SCORE (r=0.50 and r=0.52 respectively, both p<0.001). Conclusion: The differences found between the calculated vascular ages and the proportion of subjects with elevated vascular age warrants further prospective comparison of different vascular age calculation methods

A Propensity-Matched Comparison of Ischemic Brain Lesions on Postprocedural MRI in Endovascular versus Open Carotid Artery Reconstruction

(1) Study purpose: The aim of our prospective single-center, matched case–control study was to compare the number and volume of acute ischemic brain lesions following carotid endarterectomy (CEA) versus carotid artery stenting (CAS) using a propensity-matched design. (2) Methods: Carotid bifurcation plaques were analyzed by using VascuCAP software on CT angiography (CTA) images. The number and volume of acute and chronic ischemic brain lesions were assessed on MRI scans taken 12–48 h after the procedures. Propensity score-based matching was performed at a 1:1 ratio to compare the ischemic lesions on postinterventional MR. (3) Results: A total of 107 patients (CAS, N = 33; CEA, N = 74) were included in the study. There were significant differences in smoking (p = 0.003), total calcification plaque volume (p = 0.004), and lengths of the lesion (p = 0.045) between the CAS and CEA groups. Propensity score matching resulted in 21 matched pairs of patients. Acute ischemic brain lesions were detected in ten patients (47.6%) of the matched CAS group and in three patients (14.2%) in the matched CEA group (p = 0.02). The volume of acute ischemic brain lesions was significantly larger (p = 0.04) in the CAS group than in the CEA group. New ischemic brain lesions were not associated with neurological symptoms in either group. (4) Conclusions: Procedure-related new acute ischemic brain lesions occurred significantly more frequently in the propensity-matched CAS group

The Impact of Novel Reconstruction Algorithms on Calcium Scoring: Results on a Dedicated Cardiac CT Scanner

Contemporary reconstruction algorithms yield the potential of reducing radiation exposure by denoising coronary computed tomography angiography (CCTA) datasets. We aimed to assess the reliability of coronary artery calcium score (CACS) measurements with an advanced adaptive statistical iterative reconstruction (ASIR-CV) and model-based adaptive filter (MBAF2) designed for a dedicated cardiac CT scanner by comparing them to the gold-standard filtered back projection (FBP) calculations. We analyzed non-contrast coronary CT images of 404 consecutive patients undergoing clinically indicated CCTA. CACS and total calcium volume were quantified and compared on three reconstructions (FBP, ASIR-CV, and MBAF2+ASIR-CV). Patients were classified into risk categories based on CACS and the rate of reclassification was assessed. Patients were categorized into the following groups based on FBP reconstructions: 172 zero CACS, 38 minimal (1–10), 87 mild (11–100), 57 moderate (101–400), and 50 severe (4003, 4.0 (0.0–103.5) mm3 using ASIR-CV, and 5.0 (0.0–118.5) mm3 with MBAF2+ASIR-CV (all comparisons p < 0.001). The concomitant use of ASIR-CV and MBAF2 may allow the reduction of noise levels while maintaining similar CACS values as FBP measurements