简介：Surgicaloptionsdevelopedtotreatcarotidarterystenosishaveevolvedinthelastsixdecades,andstudieshaveshownthesuperiorityofcarotidendarterectomy(CEA)comparedtomedicaltherapy.Similarly,asendovasculartherapyhasevolvedoverthelasttwodecades,studiesreflectingsafety,feasibility,andequivalenceofcarotidarterystenting(CAS)toCEAhavebeenreplicatedinseveralstudiesforintermediatetohighsurgicalriskpatients.However,sinceitsinception,thefieldofCAShasbeenmiredinseveralcontroversiesandhasbeensubjecttointensescrutinyfrommultiplestakeholderswithinthefieldofmedicine.ThisreviewdiscussesspecificissuesconcerningCASthatarerelevantinthecurrentera.

简介：Coronaryarterychronictotalocclusion(CTO)isdefinedasanoccludedcoronaryarterysegmentwithoutanterogradeflowforatleastthreemonths.Itcanbeclassifiedasa“true”or“functional”CTObasedonflowcharacteristics.In“true”CTO,thereisnoanterogradeflow.In“functional”CTO,thereisminimalanterogradeflowthroughtheoccludedsegmentofthecoronaryartery.CTOisacommonfindingduringcoronaryangiographyanditsprevalencemayvarydependingonthereportedliterature.Amongpatientswithoutpreviouscoronaryarterybypassgrafting(CABG),CTOisfoundinabout20–30%ofthepatients.CTOmaydevelopinsidiouslyoveraperiodoftimeandinvolveacomplexinterplaybetweenintracellularandextracellularfactors,smoothmuscleandfoamcells,calcification,andneovascularization.ThereisagrowingbodyofevidencetosupportthatCTOrevascularizationmayimproveclinicaloutcomewhencomparedtomedicalmanagement.BoththeEuropeanandAmericancardiovascularsocietiessupportCTOrevascularizationwithaclass2arecommendation(levelofevidenceB).Historically,duetolowproceduralsuccessrate,apparentinefficientresourceutilization,potentialincreaseincomplicationratesanduncertainclinicalbenefits,onlyabout10–20%ofpatientswithCTOaretreatedwithpercutaneouscoronaryintervention(PCI).RecentadvancesusingnovelandinnovativetechniqueswithdedicatedequipmenthavesignificantlyimprovedtheproceduralsuccessrateforCTOPCItoabout90%inthehandsofexperiencedoperators.WithincreasinginterestinCTOPCIcoupledwithincreasededucationaleffort,CTOPCIlikelywillbecomemoreaccessibletopatientsinneedofCTOrevascularization.OngoingadvancementininnovativetechniquesandequipmentwillcontinuetoimproveproceduralsuccessratesandreduceproceduralcomplicationrateforCTOPCI.Furthermore,thereareanumberofprospectiveclinicaltrialsonthehorizonwhichshouldhelpdefinetheclinicalbenefitsandlimitationsofCTOPCIinthenear

简介：BackgroundIncreasedlevelofglycatedhemoglobin(HbA1c)isassociatedwithhigherincidenceofcoronaryarterydisease(CAD)inthediabetics.However,therelationshipbetweenHbA1candtheriskofcoronaryarterystenosisinthenon-diabeticsiscontroversial.MethodsAretrospectiveresearchwasconductedon338enrolledparticipantswhohaveundergone2timesofcoronaryangiographicexaminationwithinthepastyear.Clinicalandlaboratoryvariablesattheinitialandthesecondtimeofadmissionwerecollected.AccordingtotheinitialmedianHbA1clevel,allparticipantsweredividedintotwogroupsnamedlowerandhighergroups.TherelationshipbetweenHbA1clevelandtheriskofcoronaryarterystenosisovertimewasevaluated.ResultsTheinitialvaluesofHbA1cinloweranduppergroupswere5.78±0.35%and6.21±0.32%(P<0.05).Ascomparedtothelowergroup,thepercentagesofmaleandsmokingparticipants,andtheserumlevelofCRPweresignificantlyhigherinthehighergroup(P<0.05).Othertraditionalriskfactorswerecomparablebetweenthetwogroups.Therewere54.2%and55.2%participantswithsinglevesselstenosis,and45.8%and44.8%withmultiplevesselstenoses,respectivelyinthetwogroupswithoutsignificantdifference.Thesecondtimeofadmission,were308.5±25.4days(lowergroup)and300.7±30.1days(highergroup)fromtheinitialadmission.AlthoughnosignificantchangesofHbA1clevelwereobservedwhencomparedtoinitial,HbA1clevelinthehighergroupwasstillsignificantlyhigherincomparisontothelowergroup(6.24±0.39%vs.5.80±0.36%,P=0.008).Thepercentageofnewcoronaryarterystenosis(≥50%stenosis)washigherinthehighergroupthanthatinthelowergroup(41.7%vs.32.3%,P<0.001).MultivariateregressionanalysessuggestedthatHbA1cremainedindependentfactorassociatedwithcoronaryarterystenosesafterextensiveadjustmentforriskfactors.ConclusionInthenondiabetics,increasedbaselineHbA1clevelportendstheriskofcorona

简介：Therestenosisaftercoronaryarterybypassgraft(CABG)isattributedtotheformationofintimalhyperplasia(IH)attheanastomosis,whichiscloselyrelatedtohemodynamicdependonthegeometricmodel.Inordertogiveareasonableassessmentofthesurgeryeffectandjudgethelong-termpatencyrate,thehemodynamicofCABGsurgeryprogramiscomparedwiththatofsurgerydesignofthejunctionanglechanged.Basedonin-vivoCTcoronaryangiographydatasets,theindividualgeometricmodelofCABGreconstructedinsteadofidealizedgeometricmodelsareappliedtosimulatetherealphysiologicalbloodflowutilizingpulsatileflowboundarywaveformsinthepresentstudy.Thesimulationresultsshowthatthemaximumwallshearrate(WSS)valueisatthebottomofanastomosis.Moreover,thestagnationzonegrowinggraduallywiththegreaterangledownstreamtheanastomosisispronetoformtheIH,whichisconsistentwithclinicalobservation.Itisprovedthatthesurgerybeingbettersuitedtomaintaingraftpatencyissuccessful.

简介：BackgroundTheearlyendothelialdysfunctionofcarotidarteryinpatientswithtype2diabetesmellitus(T2DM)hasbeenrecognized.However,thefeasibilityandsignificanceofcarotidarteryendothelialdysfunctiondetectedbyultrasoundradio-frequencytechnologyhasbeenseldomstudied.MethodsThe2Dultrasoundimagesofthebilateralcommoncarotidarteriesfrom112casesofT2DMpatientsand50casesofnormalsubjectsinourhospitalwerecollectedtomeasureintima-mediathicknessmeans(IMTm),end-systolicinnerdiameter(Ds),end-diastolicinnerdiameter(Dd),resistanceindex(RI),pulseindex(PI),andthesystole/diastoleratio(S/D).Wealsoobservedthevariationoftheintima-mediathickness(IMT)aswellastheelasticityindexesofthecommoncarotidartery,suchasthecompliancecoefficient(CC),elasticitycoefficient(β),pulsewavevelocity(PWV)andaugmentationindex(AIx)throughinstrumentswithbuilt-inultrasoundradio-frequencytechniques,includingquantitativeintima-mediathickness(QIMT)andquantitativeanalysisofarterialstiffness(QAS).Thedifferencesoftheabove-mentionedparametersbetweenthetwogroupswereanalyzed.ResultsTherewerenostatisticallysignificantdifferencesinIMTm,Ds,Dd,RI,PIandS/DraitoofthecommoncarotidarteriesbetweengroupT2DMandthenormalgroup(P>0.01).Theβ,PWVandAIxingroupT2DMwereremarkablyhigherthanthoseinthecontrolgroup,withCCvaluebeingsignificantlylowerthanthelater(P<0.01or0.05).ConclusionUltrasoundradio-frequencytechniqueoffersearlierandmoreeffectiveevaluationofcarotidarteryendothelialdysfunctioninT2DMpatientswhencomparedwithconventional2Dultrasound,establishingimagingfoundationfortheearlypreventionandtreatmentofcardio-cerebrovascularcomplicationsinT2DMpatients.