Numerical Analysis on A Non-Critical Stenosis in Renal Artery

The increase in cardiovascular diseases worldwide has resulted in higher death rate of people globally; the primary reason being atherosclerosis. A better understanding of this condition can be achieved through the application of numerical methods to understand the haemodynamics. The present study aims to investigate the effects of renal artery angulation on the flow characteristics in a non-critically stenosed artery compared to that of a normal artery in order to understand better, the reasons for causes and progression of renal artery stenosis. Abdominal aorta-renal artery models ranging from 30° to 90° angulations were generated from computerized tomography-angiogram slices, post which they were subjected to cleanup and defeaturing. Haemodynamic parameters such as velocity, pressure and time-averaged wall shear stress were evaluated at early systole, peak systole and peak diastole for the different artery models. Extensive amounts of flow recirculation were observed in normal renal arteries with higher bifurcating angles, whereas it was not the case in stenosed arteries where flow acceleration was seen for the duration of the cardiac cycle. Evaluation of static pressure encountered a similar trend where an increase in angulation saw a decrease in pressure for normal arteries which contradicted with stenosed artery results. Analysis of shear stress saw very similar trends in normal and stenosed arteries, with lower angulation profiles experiencing higher values of shear stress at the Ostia. In the cases of arteries of higher angulation with a non-critical stenosis, the possibility of worsening of stenosis into an opprobrious stage remains a concern.

Free-floating thrombus and a fragment of atherosclerotic plaque in the lumen of the internal carotid artery – review of 2 cases

Free-floating thrombus or a fragment of atherosclerotic plaque (mobile plaque) in the lumen of the carotid artery is extremely rare. Atherosclerosis is the most common cause underlying their occurrence. The optimal treatment strategy has not been developed, at least in part due to the rarity of observations, as well as the lack of comparative studies between conservative and surgical treatment (carotid artery stenting, endovascular thrombectomy, endarterectomy). We present two cases that demonstrate the treatment tactics of these rather rare pathologies. Patient Yu., 62 years old, was hospitalized with focal neurological symptoms, National Institutes of Health Stroke Scale of 12. According to the CT of the brain, signs of an ischemic stroke in the right middle cerebral artery circulation were detected. Selective cerebral angiography diagnosed thrombosis of the arteries of the precentral and central sulcus of the right middle cerebral artery, critical stenosis of the mouth of the right internal carotid artery, and a free-floating thrombus in its lumen with a fixation point at the level of atherosclerotic plaque, which blocked the lumen of the artery by more than 60 %. Endovascular aspiration of a free-floating thrombus was performed, followed by angioplasty and stenting of critical stenosis with a favorable clinical outcome. Patient L., 73 years old, applied for carotid ultrasonography, during which a mobile atherosclerotic plaque was diagnosed at the level of the bifurcation of the right common carotid artery. Digital selective cerebral angiography confirmed a plaque fragment floating in the lumen of the artery. After applying a loading dose of ticagrelor without complications, an emergency implantation of a carotid stent was performed at the level of the bifurcation of the right common carotid artery.Taking into account the modern possibilities of interventional radiology and a wide range of tools, the endovascular approach to the treatment of complicated atherosclerotic plaque with a floating component or a formed blood clot is the best treatment option with a good safety profile.

Endovascular Repair of Radiation-induced Bilateral Common Carotid Artery Stenosis and Pseudoaneurysm with Covered and Uncovered Stent Graft using Double Embolic Protection Device

Purpose: We present an unpublished case of bilateral carotid injury due to radiation-induced treated by endovascular therapy using double embolic protection device as a novel technique. Methods: Extracranial carotid artery pseudoaneurysm is a rare condition among head and neck cancer patients treated with radio therapy. We report a case of pseudoaneurysm in the right Common Carotid Artery (CCA) and critical stenosis in the left CCA. A 72 years-old patient laryngeal cancer treated with laryngectomy and radiotherapy 26 years before admission. He presented to us complaining of right neck pain and right hemispheric TIA symptoms. Results: Performed ultrasonography and magnetic resonance angiography revealed right Common Carotid Artery (CCA) pseudoaneurysm (size:13x25 mm) and critical stenosis in the left CCA. Endovascular treatment was performed in bilateral carotid artery using covered stent in pseudoaneurysms in the right CCA and uncovered stent due critical stenosis in the left CCA using double embolic protection device. Both procedures showed successful exclusion of the pseudoaneurysm and widely patent artery. Conclusion: Endovascular treatment in injury artery radiation-induced is safe and effective approach with low rate complications. The combined use of proximal cerebral protection devices and distal filter protection could decrease the rate of cerebral embolization procedure related.

NEUROMARKERS OF ANXIETY IN A PATIENT WHO HAD EXPERIENCED A TRANSIENT ISCHEMIC ATTACK (TIA) OF THE LEFT BRAIN HEMISPHERE AS A RESULT OF A CRITICAL STENOSIS OF THE INTERNAL CAROTID ARTERY (ICA) OPERATED ON BY ENDARTERECTOMY (CEA)

The search for neuromarkers is a very promising way to improve psychiatric and psychological care. They are now considered to be an innovative diagnostic tool in psychiatry and neuropsychology, but more broadly in all human health sciences. The aim of our study was to find the neuromarker of anxiety in a patient who had experienced a Transient IschemicAttack (TIA) of the left brain hemisphere as a result of a critical stenosis of the Internal Carotid Artery (ICA) operated on byendarterectomy (CEA). We will present the case of a 54-year-old man,an architect, who experienced a Transient Ischemic Attack (TIA) of the left brain hemispherecaused by a critical stenosis of theInternal Carotid Artery (ICA) and was treated successfully with surgical endarterectomy (CEA). One year after the surgery itself, the patient developed severe postoperative anxiety, headaches, difficulty in sleepingas well as the inability to continue working in his profession. Strong anxiety was notedon the adapted 100-millimeter Visual Analogue Anxiety Scale (VAAS). The patient was assessed using the Human Brain Index (HBI) methodology (Kropotov 2009; 2016; 2017; Pąchalska, Kaczmarek&Kropotov 2014) which consisted of recording 19-channel EEG in resting state conditions, during the cued GO/NOGO task and comparing the parameters of EEG spectra and Event-Related Potentials (ERPs) with the normative and patient databases of the Human Brain Index(HBI). No signs of cognitive dysfunction was found, however an excessive Rolandic beta was observed. In line with the working hypothesis as to the presence of an anxiety neuromarker, the patient’s studies confirmed an increased P1 time wave in the left hemisphere of the brain in ERP in response to visual stimuli, i.e. an anxiety neuromarker. Following the detection of this neuromarkera specific anodic Transcranial Direct Current Stimulations (tDCS) protocol was proposed (see: Kropotov 2016; Pąchalska, Kaczmarek & Kropotov 2020). Ten tDCS sessions were performed and the postoperativeanxiety was found to be resolved. The patient returned to work. The use of Human Brain Index (HBI) methodologyenabling the isolation of the Event Related Potentials (ERPs) patterns revealed the presence of a distinct anxietyneuromarker. Neurotherapy with the use of tDCS allowed the reduction of anxiety symptoms and the patient’s return to work. The above case study indicates the necessity to use new neurotechnologies in the diagnosis of mental diseases, with particular emphasis on postoperative anxiety.

Cerebrovascular disease progression in patients with ACTA2 Arg179 Pathogenic Variants

Objective:To establish progression of imaging biomarkers of stroke, arterial steno-occlusive disease and white matter injury in patients with smooth muscle dysfunction syndrome caused by mutations in the ACTA2 gene, we analyzed 113 cerebral MRI scans from a retrospective cohort of 27 patients with ACTA2 Arg179 pathogenic variants.Methods:Systematic quantifications of arterial ischemic strokes and white matter lesions were performed on baseline and follow-up scans using planimetric methods. Critical stenosis and arterial vessel diameters were quantified applying manual and semi-automated methods to cerebral MR angiograms. We then assessed correlations between arterial abnormalities and parenchymal injury.Results:We found characteristic patterns of acute white matter ischemic injury and progressive internal carotid artery stenosis during infancy. Longitudinal analysis of patients older than 1.2 years showed stable white matter hyperintensities but increased number of cystic-like lesions over time. Progressive narrowing of the terminal internal carotid artery occurred in 80% of patients and correlated with the number of critical stenosis in cerebral arteries and arterial ischemic infarctions. Arterial ischemic strokes occurred in same territories affected by critical stenosis.Conclusions:We found characteristic, early and progressive cerebrovascular abnormalities in patients with ACTA2 Arg179 pathogenic variants. Our longitudinal data suggests that while steno-occlusive disease progresses over time and is associated with arterial ischemic infarctions and cystic-like white matter lesions; white matter hyperintensities can remain stable over long periods. Above evaluated metrics will enable diagnosis in early infancy and be used to monitor disease progression, guide timing of stroke preventive interventions and assess response to current and future therapies.