scholarly journals Vulnerable Plaques Producing an Acute Coronary Syndrome Exhibit a Different CT Phenotype than Those That Remain Silent

2020 ◽  
Vol 6 (2) ◽  
pp. 26-34
Author(s):  
Răzvan-Andrei Licu ◽  
Emanuel Blîndu ◽  
Diana Opincariu ◽  
Theodora Benedek
Keyword(s):  
Computed Tomographic Angiography ◽  
Control Group ◽  
Atheromatous Plaque ◽  
Computed Tomographic ◽  
Coronary Syndrome ◽  
Vulnerable Plaques ◽  
Risk Of Rupture ◽  
Risk Patients ◽  
And Gender ◽  
Tomographic Angiography

AbstractBackground: All plaques that trigger acute coronary syndromes (ACS) present various characteristics of vulnerability. However, not all vulnerable plaques (VP) lead to an ACS. This raises the question as to which of the established CT vulnerability features hold the highest probability of developing ACS.Aim: To identify the distinct phenotype of VP that exposes the unstable atheromatous plaque to a higher risk of rupture.Material and Methods: In total, 20 patients in whom cardiac computed tomographic angiography (CCTA) identified the presence of a vulnerable plaque and who developed an ACS within 6 months after CCTA examination were enrolled in the study, and compared to 20 age- and gender-matched subjects with VPs who did not develop an ACS. All included patients presented VPs at baseline, defined as the presence of minimum 50% degree of stenosis and at least one CT marker of vulnerability (low attenuation plaques [LAP], napkin-ring sign [NRS], positive remodeling [PR], spotty calcifications [SCs]).Results: The two groups were not different in regards to age, gender, cardiovascular risk factors, and comorbidities. Patients who developed an ACS at six months presented higher volumes of lipid-rich (p = 0.01) and calcified plaques (p = 0.01), while subjects in the control group presented plaques with a larger fibrotic content (p = 0.0005). The most frequent vulnerability markers within VPs that had triggered ACS were LAPs (p <0.0001) and PR (p <0.0001). Multivariate analysis identified LAP as the strongest independent predictor of ACS at 6 months in our study population (OR 8.18 [1.23-95.08], p = 0.04).Conclusions: VPs producing an ACS exhibit a different phenotype compared to VPs that remain silent. The CCTA profile of VPs producing an ACS includes the presence of low attenuation, positive remodeling, and lipid-rich atheroma. The presence of these features in VPs identifies very high-risk patients, who can benefit from adapted therapeutic strategies in order to prevent an ACS.

Efficiency Assessment of Multidetector-Row Computed Tomographic Angiography Using Reconstruction With Locoregional Perforator Flaps

2021 ◽  
pp. 229255032110247
Author(s):  
Pavlo O. Badiul ◽  
Sergii V. Sliesarenko ◽  
Nataliia O. Cherednychenko ◽  
Olga V. Morgun
Keyword(s):  
Perforator Flap ◽  
Computed Tomographic Angiography ◽  
Surgical Reconstruction ◽  
Patient Treatment ◽  
Controlled Study ◽  
Control Group ◽  
Perforator Flaps ◽  
Multidetector Row ◽  
Computed Tomographic ◽  
Tomographic Angiography

Background: Reconstruction with the use of perforator flaps makes it possible to make the skin surface resistant to the influence of mechanical factors and as similar to the lost skin cover as possible. However, while planning any flap, along with the design of the required shape and size, its blood supply should be taken into account to ensure optimal viability. Therefore, the task to precisely determine the topographic–anatomical relationships suitable for the formation of a pedicle of perforators is still relevant. The aim of this study was to increase the efficiency of surgical reconstruction of wound defects by transposition of locoregional perforator flaps. Methods: The authors conducted a retrospective analysis of 72 cases of reconstruction by means of locoregional perforator flaps with vascular pedicle detachment to determine the efficiency of preoperative diagnostic preparation with the help of multidetector-row computed tomographic angiography (MDCT) in the process of reconstruction. Thirty-seven individual cases of surgical interventions were chosen using a case-controlled study from the study group when MDCT with angiography was used for preoperative planning of perforator flaps, as well as 35 control cases similar in terms of important predictive peculiarities with the reconstruction at the same level of difficulty. The patient groups were precisely matched by gender ( P = .950), age ( P = .804), flap area ( P = .192), and type of reconstruction that was performed. Results: In all cases, the location of the perforator with a diameter greater than 1.0 mm was marked. All perforators determined during MDCT scanning were faultlessly localized intraoperatively. The distance between the intraoperative position of the perforator and the position obtained in the result of the examination did not exceed 1 cm. There was no need to change the planned design of the flap intraoperatively. In all cases where MDCT was performed, the duration of the surgical procedure varied from 60 to 150 minutes (average: 120.77 [18.90] minutes) and was reduced by 49.40 minutes (95% CI: 39.17-59.63) compared with the patients who did not undergo preoperative visualization of perforators where the average duration of the operation was 170.17 (19.19) minutes (from 140 to 220 minutes). Among the patients examined by MDCT, surgical complications were noted in 5 cases (13.51%) compared to 14 cases (40.00%) in the control group. Conclusions: The preoperative MDCT for the locoregional perforator flap reconstruction makes it possible to increase the efficiency of patient treatment given the reduction in surgery duration by 49.40 minutes (95% CI: 39.17-59.63) on average and the reduction in the level of postsurgery complications from 40% to 13.5% compared with the group of patients in whom presurgical visualization was not performed ( P = .031).

Quantified coronary total plaque volume from computed tomography angiography provides superior 10-year risk stratification

2020 ◽  
Author(s):  
Simon Deseive ◽  
Maximilian Kupke ◽  
Ramona Straub ◽  
Thomas J Stocker ◽  
Alexander Broersen ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Computed Tomographic Angiography ◽  
Study Endpoint ◽  
Plaque Volume ◽  
Coronary Cta ◽  
Computed Tomographic ◽  
Coronary Syndrome ◽  
Coronary Artery Disease Severity ◽  
Net Reclassification Improvement ◽  
Tomographic Angiography

Abstract Aims  Automated coronary total plaque volume (TPV) quantification derived from coronary computed tomographic angiography (CTA) datasets provide exact and reliable assessment of calcified and non-calcified coronary atherosclerosis burden. The aim of this analysis was to investigate the long-term predictive value of TPV. Methods and results  TPV was quantified in 1577 patients undergoing coronary CTA and cardiovascular events were collected during 10.5 years (interquartile range 6.0–11.4) of follow-up. The study endpoint comprised cardiac death and acute coronary syndrome and occurred in 59 (3.7%) patients. Coronary TPV provided additive prognostic value over clinical risk assessed with the Morise Score and coronary artery disease severity (rise in C-index from 0.744 to 0.769, P = 0.03). A category-based reclassification approach combining the Morise Score and TPV revealed superior risk stratification (categorical net reclassification improvement: 0.48 with 95% CI 0.13–0.68, P &lt; 0.001) and resulted in reclassification of 800 (51%) patients compared with the Morise Score alone. The 10-year risk for the study endpoint was 0.6% (95% CI 0–1.3) for patients classified as low risk (n = 807), 4.8% (95% CI 2.4–7.2) for patients at intermediate risk (n = 400), and 10.3% (95% CI 6.6–13.9) for patients at high risk (n = 370) using the combined reclassification approach. Conclusion  Quantification of TPV from coronary CTA permits an improved 10-year cardiovascular risk stratification.

scholarly journals CARDIAC COMPUTED TOMOGRAPHIC ANGIOGRAPHY IN THE ASSESSMENT OF LOW RISK PATIENTS: AN UPDATED META-ANALYSIS

2016 ◽  
Vol 67 (13) ◽  
pp. 1751
Author(s):  
Abel Casso Dominguez ◽  
Georges El-Hayek ◽  
Elizabeth Contreras ◽  
Alexandre Benjo ◽  
Edgar Argulian ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Computed Tomographic Angiography ◽  
Low Risk ◽  
Computed Tomographic ◽  
Risk Patients ◽  
Cardiac Computed Tomographic Angiography ◽  
Tomographic Angiography

QUANTITATIVE MORPHO-FUNCTIONAL ANALYSIS OF SIMMETRY-ASIMMETRY CONDITION OF HUMAN NORMAL KIDNEY

2020 ◽  
Vol 23 (1) ◽  
pp. 1-6
Author(s):  
M. Dgebuadze ◽  
G. Svanidze ◽  
D. Gachechiladze
Keyword(s):  
Functional Analysis ◽  
Renal Artery ◽  
Computed Tomographic Angiography ◽  
Renal Diseases ◽  
Morphometric Study ◽  
Computed Tomographic ◽  
Kidney Length ◽  
And Gender ◽  
Tomographic Angiography ◽  
Quantitative Indicators

The aim of the present research was to perform quantitative morpho-functional analysis of the symmetry-asymmetry condition of human normal autopsy and “live” kidneys using the complex of morphological and ultra-sonographic methods. METHODS: Morphometric study of 10 autopsy kidneys of healthy men 36 - 60 years of age was conducted; retrospective analysis of data obtained by vital ultra-sonographic study of 65 kidneys of men without renal diseases at the same age period was performed as well. All kidneys were with a single renal artery. RESULTS: The kidney length and width are statistically significantly greater on right, than on left, but there were no statistically significant differences between right and left kidneys in thickness of the kidney and size of its parenchyma. Results of morphometric study of autopsy renal glomeruli, as well as multislice computed tomographic angiography and doppler investigation of renal artery in color duplex scan mode did not show any statistically significant differences on right and on left. CONCLUSIONS: For determining of the standard quantitative indicators of kidney it is necessary to take into account the age and gender of the studied people, as well as the effect of side.

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