Comparison of Different Metrics for the Identification of Vascular Changes in Diabetic Retinopathy Using OCTA

Retinal vessel metrics identifying microvascular changes such as vessel closure (VC) have shown potential clinical value by identifying eyes with diabetic retinopathy (DR) at different severity levels and at increased risk for disease progression to more severe stages. We compare the performance of 11 different metrics, which include 2 metrics supplied by the manufacturer, based on OCTA for identification of VC in different Early Treatment for Diabetic Retinopathy Study (ETDRS) severity groups. OCTA en-face slabs from 84 healthy eyes (70 ± 4.8 years) and 78 eyes of diabetic individuals (67 ± 7.5 years) were processed using different methods that include abnormal intercapillary spaces (AIS), vessel density (VD), and nine metrics extracted from the en-face slab. The best separation between the eyes with DR and the control group was obtained in the superficial capillary plexus (SCP), with the full retina (FR) also performing well. In the SCP, the metrics that show better performance were the AIS and the VD with a value of area under curve (AUC) equal to 0.89 [95% CI 0.84–0.94] and 0.85 [95% CI 0.79–0.91], respectively, indicating that the VD metric supported by the manufacturer is satisfactory. The values of these metrics on the different ETDRS groups show a progressive increase in VC, which is correlated with disease severity.

Use of sirolimus-coated balloon in de novo lesions; Mid-term follow-up from a single-centre registry

Introduction Use of drug coated balloons (DCBs) in coronary intervention is escalating and the guidelines recommend its use in restenotic lesions. However, recent data suggest it can also be considered in a subset of denovo lesions especially; small vessels, ostium of an important side-branch and in patients unable to tolerate dual antiplatelet therapy for a prolonged period. Most DCBs used elute Paclitaxcel, but there is no data on Sirolimus eluting DCB, which is the drug of choice in currently available drug eluting stents. In this study, we report outcomes from the use of a Sirolimus coated balloon (SCB) in de novo coronary lesions. Methods We retrospectively analysed all patients treated with an SCB between April and December 2018. Results are reported as cardiac death, target vessel myocardial infarction (TVMI), target lesion revascularisation (TLR), target vessel revascularisation (TVR) and MACE (combination of cardiac death, target vessel MI and TLR). Results During the study period, 351 patients (with 414 lesions) with de novo lesions were treated with an SCB. The mean age of patients was 65.6±11.5 years, 275 (78%) were male and 39% (n=212) had diabetes. Most lesions treated were in the LAD/diagonal system (n=173, 42%). Predilatation was performed in 98% (405 lesions). Bailout stenting (with a drug eluting stent) was required in 7% lesions (n=30), of which 11 were due to dissections and 19 were due to recoil >50% following DCB use. The mean diameter and length of DCBs were 2.47 mm and 26 mm respectively. During a median follow-up of 322-days (11-months) cardiac death was reported in 8 patients (2.3%). Target vessel MI was in 3%; n=10, TLR and TVR per lesion were 8% (n=34) and 9% (n=37) respectively. The MACE rate was 11%. There were no documented cases of acute vessel closure. Conclusion The mid-term outcome from the first ever study on sirolimus coated balloons in de novo lesions appears promising with low rates of hard endpoints with no documented cases of acute vessel closure. The MACE rates appear promising, although we need longer follow-up which is ongoing and we will be able to report outcomes from even longer follow-up during the presentation. FUNDunding Acknowledgement Type of funding sources: None.

Optical Coherence Tomography Angiography Metrics Monitor Severity Progression of Diabetic Retinopathy—3-Year Longitudinal Study

To examine retinal vessel closure metrics and neurodegenerative changes occurring in the initial stages of nonproliferative diabetic retinopathy (NPDR) and severity progression in a three-year period. Methods: Three-year prospective longitudinal observational cohort of individuals with type 2 diabetes (T2D), one eye per person, using spectral domain-optical coherence tomography (SD-OCT) and OCT-Angiography (OCTA). Eyes were examined four times with one-year intervals. OCTA vessel density maps of the retina were used to quantify vessel closure. Thickness of the ganglion cell + inner plexiform layer (GCL + IPL) was examined to identify retinal neurodegenerative changes. Diabetic retinopathy ETDRS classification was performed using the seven-field ETDRS protocol. Results: A total of 78 eyes/patients, aged 52 to 80 years, with T2D and ETDRS grades from 10 to 47 were followed for 3 years with annual examinations. A progressive increase in retinal vessel closure was observed. Vessel density (VD) showed higher decreases with retinopathy worsening demonstrated by step-changes in ETDRS severity scale (p < 0.001). No clear correlation was observed between neurodegenerative changes and retinopathy progression. Conclusions: Retinal vessel closure in NPDR correlates with DR severity progression. Our findings provide supporting evidence that OCTA metrics of vessel closure may be used as a surrogate for DR severity progression.

Pilot study of minimum occlusive force of vascular clamps on arterial vessels in rats

Our aims were to determine the accuracy of an improved formula for determining the minimum occlusive force (MOF) of a vascular clamp on rats’ abdominal aortas, compare our findings with the calculated theoretical MOF, and provide reference data for clinical research and development of medical instruments that cause minimal damage. We created a vessel closure model and developed a formula for calculating the theoretical MOF of arterial vessels when they are occluded. This formula utilises the blood pressure in the blood vessel, its diameter, and the width of the vascular clamp. We then measured the actual MOF in 24 rat abdominal aortic segments with different diameters and different blood pressures and compared the theoretical and actual MOFs. Analysis of the experimental data showed a probability of 0.315, which means that, under the condition of normal distribution, the difference between the theoretical and actual MOF is not significant at the α = 0.05 level. Thus, the actual measured MOF tended to be consistent with the theoretical MOF calculated by the formula we developed. The improved formula will provide a reference for clinical research and development of medical instruments that cause minimal injury, thus contributing to the development of microsurgery.

Sex Differences in the Inflammatory Response: Pharmacological Opportunities for Therapeutics for Coronary Artery Disease

Coordinated molecular responses are key to effective initiation and resolution of both acute and chronic inflammation. Vascular inflammation plays an important role in initiating and perpetuating atherosclerotic disease, specifically at the site of plaque and subsequent fibrous cap rupture. Both men and women succumb to this disease process, and although management strategies have focused on revascularization and pharmacological therapies in the acute situation to reverse vessel closure and prevent thrombogenesis, data now suggest that regulation of host inflammation may improve both morbidity and mortality, thus supporting the notion that prevention is better than cure. There is a clear sex difference in the incidence of vascular disease, and data confirm biological differences in inflammatory initiation and resolution between men and women. This article reviews contemporary opinions describing the sex difference in the initiation and resolution of inflammatory responses, with a view to explore potential targets for pharmacological intervention.

Complications of chronic total occlusion percutaneous coronary intervention

Chronic total occlusion percutaneous coronary interventions can be highly complex and are associated with an increased risk of complications, such as perforation, acute vessel closure (which can lead to rapid haemodynamic compromise if it involves the donor vessel), and equipment loss or entrapment. Awareness of the potential complications and meticulous attention to equipment position and patient monitoring can help minimise the risk of complications and allow prompt treatment should they occur.

One Stage Minimally Invasive Thoracoscopic Lung Resection and Transphrenic Adrenalectomy

Surgery may offer a long-term survival benefit to a small proportion of patients with operable non-small cell lung cancer (NSCLC) and solitary adrenal metastasis. Several approaches to lung resection with a separate open or laparoscopic adrenalectomy have been advocated. We present a technique that allows a single incision, single operation through a transdiaphragmatic approach to the ipsilateral adrenal gland following lung resection through a video assisted thoracic surgery (VATS) approach. By using this approach, along with an advanced bipolar device to aid adrenal dissection and clip-less vessel closure, both lobectomy and adrenalectomy can be carried out safely and effectively with minimal perioperative and postoperative morbidity.