Intracranial Involvement in Takayasu’s Arteritis

Takayasu’s arteritis (TAK) is a large-vessel vasculitis that targets the aorta and its major branches. Although extracranial vascular involvement is uniformly present in this disease, the frequency of intracranial involvement in TAK has not been well studied. We retrospectively reviewed the clinical and imaging records of patients diagnosed with TAK at a single Canadian university medical centre to determine the prevalence of intracranial vascular involvement. Intracranial vascular and non-vascular findings were described, and a review of the literature was performed. Of 20 patients with TAK, 12 had vascular neuroimaging completed. Intracranial vascular lesions were identified in 4 patients (33.3% of those with imaging available, 20% of all patients). The frequency of intracranial vessel involvement in TAK may be more common than appreciated. Imaging of both the intra- and extra-cranial vessels should be considered in these young patients.

Impact of body mass index on duplex parameters of cranial vessels among the Egyptian population

Background Obesity is a major health problem that affects different vascular systems, including cerebrovascular circulation. Carotid duplex is the best screening tool for early diagnosis of cerebrovascular changes in relation to different risk factors including obesity. The present study aims to evaluate the effect of body mass index on the parameters of extracranial vessels in healthy subjects using vascular duplex ultrasonography. Results The intimal medial thickness in the common carotid is found to increase as the body mass index and body weight increase (directly related), with this increase being significant (P-value < 0.05). Conclusion These findings indicate that increase in body mass index can adversely affect duplex parameters of the common carotid artery. Clinical trial registration NCT03252652. Registered August 16th 2017

POS0821 THE DIFFERENT SUBTYPES OF GIANT CELL ARTERITIS BY ULTRASOUND: RESULTS FROM A FAST-TRACK CLINIC

Background:Giant cell arteritis (GCA) is a vasculitis that affects the medium and large vessels (LV). Although cranial artery involvement is better known, awareness of the importance of LV involvement is increasing. Imaging techniques currently constitute the basis for the diagnosis of LV-GCA and have improved its diagnosis and prevalence. In recent years, differences in clinical patterns and different inflammatory and etiopathogenic mechanisms of the disease have been suggested. Therefore, improving sensitivity to diagnosis is essential to improve the knowledge and care of our population.Objectives:The aim of this study was to know the prevalence of the different ultrasound patterns of GCA in our area.Methods:Retrospective records of available data were collected from all patients referred to our ACG fast track clinic in the past three years. The clinical and laboratory characteristics were evaluated at the time of referral. All patients underwent an ultrasound scan of cranial vessels (superficial temporal arteries (TA) and their frontal and parietal branches) and large vessels (axillary, subclavian and carotid arteries). The doctor confirmed the GCA diagnosis after at least six months of follow-up. The OMERACT definitions of halo sign with a hypoechoic wall thickness ≥ 0.34 mm were used for TA pathology for the ultrasound diagnosis of GCA and for axillary, subclavian and carotid arteries and homogeneous hypoechoic thicknesses ≥ 1 mm of the arterial wall were applied. Atherosclerosis lesions were evaluated to detect this disease as a possible false positive halo sign. An Esaote Mylab Twice with a 13 MHz probe in BT and 22 MHz for cranial vessels in 2017-2019 and an Esaote Mylab X8plus with a 15 MHz probe for BT and a 24 MHz probe for cranial arteries in 2019-2020 were used by two rheumatologist with long experience in ACG ultrasound.Results:A total of 261 patients (180 women / 81 men) with suspected GCA were evaluated in our fast track clinic. The mean age (± SD) was 76 ± 9.2 years and CRP at diagnosis was 75.7 ± 68.6 mg/L. The time elapsed since the first symptoms was less than 6, 6-12, 12-24 or >24 weeks in 37.5%, 19.9%, 12.3% and 15.7% respectively. Of the 261 cases explored, 160 had GCA, of which 102 were women and 58 men, and had a mean age of 77.21 ± 7.9 years. The ultrasound patterns of GCA were: 71 patients had exclusive involvement of the TA (cranial-GCA), 54 had a mixed pattern with involvement of both TA and LV (mixed-CGA), and 35 had isolated involvement of the LV (LV-GCA). That is, 125 patients had cranial involvement with or without LV involvement and 89 had LV-GCA associated or not with cranial involvement (Figure 1).Figure 1.Ultrasound patters of GCAConclusion:Ultrasound is a useful tool for the screening of GCA and its different subtypes of vascular involvement. The isolated cranial subtype or associated with LV-GCA is the most common (78% of cases), but LV-GCA is also very common (55.6% of cases of GCA) and 21.9% presents as an isolated LV-GCA standard. The LV arteries should be included in the ultrasound examination for suspected GCA.Disclosure of Interests:Irene Monjo Speakers bureau: Roche, Novartis, UCB, Gedeon Richter, Consultant of: Roche, Elisa Fernández-Fernández: None declared, Javier Ortega: None declared, Eugenio de Miguel Speakers bureau: AbbVie, Novartis, Pfizer, MSD, BMS, UCB, Roche, Grunental, Janssen, Sanofi, Paid instructor for: Janssen, Novartis, Roche, Consultant of: AbbVie, Novartis, Pfizer, Galapagos, Grant/research support from: Abbvie, Novartis, Pfizer

INFLUENCE OF ADVERSE PRODUCTION FACTORS ON CEREBRAL HEMODYNAMIC IN LOCOMOTIVE DRIVERS

The aim: To investigate the pathological changes in intra- and extra cranial blood vessels in workers of locomotive crews depending on their length of service. Materials and methods: The study involved 249 male patients, aged from 21 to 60 years who worked as locomotive drivers. We used Doppler examination and studied Doppler Indexes of cerebral vessels. Results: Results of examination showed that with increasing length of work of workers of locomotive crews (together with increasing of their age) we have established: 1) Reduction the elasticity of blood vessels (77.6% of the patients); 2) Increased violation of venous circulation (86.4%); 3) Reduced blood flow in the basilar artery (64%); 4) Reduced blood flow in the right and left vertebral arteries (65.6% and 65.5% respectively); 5) Increase in the thickness of intimate / media complex more than 1.1 in 62 % of drivers. All of that also connected with length of their work. Conclusions: we founded that speed of blood flow and elasticity in intra- and extra cranial vessels reduced with increase the length of service of workers of locomotive crews. Also we received such results: increasing violation of venous circulation, reducing blood flow in the basilar artery and reducing of blood flow in right and left vertebral arteries, increase intima / media thicknesses greater than 1,1 in locomotive drivers.

Magnetic Resonance Imaging Based Flow Field and Lagrangian Particle Tracking From a Left Ventricular Assist Device

This study explores the optimal left ventricular assist device (LVAD) cannula outflow configuration in a patient-specific replica of the aorta. The volumetric velocity field is measured using phase-contrast magnetic resonance imaging (PC-MRI) under a physiologically relevant steady flow. The effect of the LVAD outflow graft insertion site and anastomosis angle on the transport of embolic particles to cranial vessels is studied by solving the particle equation of motion for spheres in the range of 0.1–1.0 mm using the measured three-dimensional (3D) velocity field. Results show that for a given aorta anatomy, it is possible to design the cannula graft location and terminal curvature so that the probability of embolic transport to the cranial vessels is significantly minimized. This is particularly important since the complex flow pattern in each cannula case affects the embolic trajectories differently, and hence the common assumption that particles distribute by the volumetric flow division does not hold.

Giant cell arteritis: advances in diagnosis and management

Giant cell arteritis has been widely studied throughout the world. Involvement of cranial vessels can lead to visual loss and strokes. This review primarily focusses on the presentation, diagnosis and treatment. The last 10 years have brought dramatic improvements in the imaging and medical therapies for this condition. After the American College of Rheumatology suggested criteria for the diagnosis of giant cell arteritis, many studies have been performed to find alternatives to a temporal artery biopsy. There is growing evidence that a biopsy may not be needed when one can make a convincing clinical and radiological diagnosis. Although glucocorticoids are the mainstay of treatment and their role has not changed, various biological and non-biological therapies are being used to reduce relapses and prolong remission of symptoms.

Contrast Enhanced Vascular Imaging Used in the Diagnosis of a Carotid Body Tumor: A Case Report

Carotid body tumors (CBT) are a rare form of paragangliomas of the head and neck. They are described as rare, slow-growing, mostly benign, clinically silent tumors of neural crest cells. This tumor should be considered as a differential diagnosis when evaluating a lateral neck mass. A report of a rare case, a carotid body tumor, is presented that was incidentally noted as a lateral neck mass during a screening sonogram. A mass located at the level of the left carotid bifurcation demonstrated significant vascular flow with the use of contrast enhanced ultrasound (CEUS) techniques. Computed tomography angiography (CTA) was also performed to further analyze the tumor’s anatomical relation to the extra cranial vessels.

Test setup for characterizing the efficacy of embolic protection devices

Systems for embolic protection are applied during the dilatation and the implantation of stents in the carotid artery. They are used to avoid downstream drift of arterial plaque particles which may be released during the intervention. Such particulate debris increases the risk of stroke when reaching and occluding even minor cranial vessels. Embolic protection devices (EPD) are intended to collect such particles during intervention and to finally remove them.A test setup was developed in order to assess the effi-cacy of commercially available EPDs. The setup considers the introduction of relevant particles, as well as typical anatomic conditions. The EPDs could be tested using curved and ovalized vessel types to simulate stressed vessel conditions. Furthermore, a method for counting the particles was established to quantify collected particles in the EPD, the leaked particles and those which were left behind in the vessel.

Calcitonin Gene Related Peptide Gene Polymorphism in Migraine Patients

Objective:Calcitonin gene related peptide (CGRP), which has a vasodilator effect, is held responsible for neurogenic inflammation and vasodilatation of the cranial vessels in migraine pathophysiology. In this study, we investigated the association between alpha CGRP gene polymorphism (CALCA T-692C) and migraine.Material and Methods:One hundred and thirty-four female migraineurs and 96 healthy female cases were enrolled in the study. The patient group was further subdivided into migraine with and without aura groups. The CALCA T-692C gene polymorphism was identified using polymerase chain reaction (PCR) technique and restriction fragment length polymorphism (RFLP).Results:The genotype and allele frequencies of CALCA T-692C gene polymorphism did not differ between the migraine and control groups. Between the migraine with and without aura subgroups, there was no difference. No association was seen between the CALCA T-692C gene polymorphisms and migraine attack severity and frequency.Conclusion:Our study did not show any association between CALCA T-692C gene polymorphism and migraine.