UNASSIGNED: Transthoracic echocardiography (TTE) has traditionally been the primary method for coronary imaging in children with Kawasaki disease (KD). We aimed to evaluate coronary artery lesions (CALs) of the left circumflex artery (LCx) in KD on computed tomography coronary angiography (CTCA).
UNASSIGNED: Over a 9-year period (November 2013-December 2022), 225 children with KD underwent radiation-optimized CTCA on a 128-slice dual-source platform. TTE was performed on the same day, or a day prior or after CTCA.
UNASSIGNED: On CTCA, LCx CALs were seen in 41/225 (18.2%) patients. However, TTE detected CALs in only one third of these patients [15/41 (36.6%)]. CTCA showed 47 LCx CALs in 41 patients-aneurysms in 39 patients (40 fusiform, 2 saccular; 7 giant aneurysms), stenoses in 3, and thrombosis in 2. Thromboses and stenoses were both missed on TTE. Proximal LCx aneurysms were seen in 39 patients-of these, 12 had distal extension. Six patients had distal LCx aneurysms without proximal involvement and 2 non-contiguous multiple aneurysms. Four (9.75%) patients had isolated LCx involvement. Based on CTCA findings, treatment protocols had to be modified in 3/41 (7.3%) patients.
UNASSIGNED: This study highlights anatomical findings of LCx involvement in KD. Isolated LCx CALs were noted in 4/41 (9.75%) patients. TTE alone proved inadequate for LCx assessment in children with KD. With abnormalities detected in 18.2% of cases, including those missed by TTE, CTCA emerges as an essential imaging modality. The findings have implications for treatment planning and follow-up strategies in children with KD.
UNASSIGNED: None.

Controversy still exists regarding how much the inflow arterial percutaneous transluminal angioplasty (PTA) contributed to maintaining fistula function for hemodialysis. We aimed to analyze patency and risk factors after inflow arterial PTA. Hemodialysis patients with inflow arterial primary stenosis who were admitted to our institution from January 2017 to December 2022 were examined. One group had arterial-venous fistula with inflow artery stenosis alone (AVF + iAS) and another group had AVF with inflow artery stenosis and any vein stenosis (AVF + iAS + VS). The characteristics of patients, stenotic lesions, and PTA procedures were recorded. Kaplan-Meier analysis was used to compare primary patency, assisted primary patency, and secondary patency in the two groups. Cox proportional hazard analysis was used to identify risk factors associated with patency. We examined 213 patients, 53 in the AVF + iAS group (51 radial arterial stenosis and 2 ulnar arterial stenosis) and 160 in the AVF + iAS + VS group (159 radial arterial stenosis and 1 ulnar arterial stenosis). Kaplan-Meier analysis indicated the AVF + iAS group had better primary patency and assisted primary patency (both P < 0.05), but the groups had similar secondary patency. Cox proportional hazard analysis indicated that none of the analyzed clinical and biochemical indexes had clinically meaningful effects on primary patency, assisted primary patency, or secondary patency in either group. The patency and safety after PTA for inflow arterial stenosis were satisfactory, and none of the examined risk factors had a major clinical impact on patency. We recommend PTA as treatment for inflow stenosis of an AVF.

The arteriovenous fistula constitutes the vascular access of first choice in hemodialysis. We present three clinical cases that highlight the resolution in interventional radiology of venous stenosis, one of the major complications. Clinical monitoring and instrumental diagnostics with color Doppler ultrasound have prevented the failure of the AVF due to high risk of thrombosis. The angiographic interventions, thanks to the collaboration between Spoke and Hub, were completed without complications.

BACKGROUND: Periprocedural antiplatelet treatment is a key determinant for the risk-benefit balance of emergent carotid artery stenting (eCAS) during stroke endovascular treatment (EVT). We aimed to assess the safety and efficacy profile of cangrelor compared with glycoprotein IIb/IIIa (GPIIb/IIIa) inhibitors or aspirin monotherapy.
METHODS: Data were extracted from the Endovascular Treatment in Ischemic Stroke (ETIS) registry, a prospective nationwide observational registry of stroke EVT in France. Included patients were treated with eCAS for anterior circulation tandem lesions between January 2015 and June 2023 and received periprocedural treatment with cangrelor, GPIIb/IIIa inhibitors or aspirin monotherapy. The primary outcome was functional outcome at 90 days, assessed by the modified Rankin Scale (mRS). Secondary outcomes included intracranial recanalization, hemorrhagic transformation and carotid stent patency at day 1.
RESULTS: Of the 1687 patients treated, 384 met the inclusion criteria: 91 received cangrelor, 77 received GPIIb/IIIa inhibitors and 216 aspirin monotherapy. Cangrelor was associated with a negative shift in the distribution of mRS scores compared with GPIIb/IIIa inhibitors (aOR 0.48, 95% CI 0.25 to 0.94, P=0.033). Compared with aspirin, cangrelor improved carotid stent patency at day 1 (aOR 4.00, 95% CI 1.19 to 14.29, P=0.025) but showed no significant differences in clinical outcomes. There were no differences in outcomes between full dose and low dose cangrelor. GPIIb/IIIa inhibitors demonstrated higher odds of functional independence (aOR 2.56, 95% CI 1.08 to 6.25, P=0.033) compared with aspirin.
CONCLUSIONS: This registry-based study indicates a potential trend towards lower odds of favorable clinical outcomes with cangrelor treatment compared with GPIIb/IIIa inhibitors. However, these findings should be interpreted with caution due to potential selection bias and warrant further research for validation.

BACKGROUND: Cerebral venous pressures, sinus trans-stenosis gradients, and intracranial pressures are thought to be influenced by head position.
OBJECTIVE: To investigate the intracranial manifestations of these changes in patients with cerebral venous outflow disorders (CVD).
METHODS: A retrospective chart review was conducted on 22 consecutive adult patients who underwent diagnostic cerebral venography with rotational internal jugular vein (IJV) venography and superior sagittal sinus (SSS) pressure measurements in multiple head positions. Data on venous sinus pressures, IJV pressures, and lumbar puncture (LP) opening pressures (OP) were collected and analyzed.
RESULTS: The study found that 21 (96%) patients experienced increases in SSS pressures with head rotation, with a mean increase of 25.4%. Intracranial trans-stenosis gradients showed significant variability with head position. Additionally, LP OP measurements increased by an average of 44.3% with head rotation. Dynamic IJV stenosis was observed in all patients during rotational testing.
CONCLUSIONS: Head position significantly affects cerebral venous pressures, trans-stenosis gradients, and intracranial pressures in patients with CVD or intracranial hypertension. These findings highlight the need for dynamic venography in the diagnostic evaluation of these conditions to better understand their pathophysiology and improve treatment strategies.

暂无摘要。

Purpose: The primary objective of the conducted research was to develop an urological stent design for the treatment of male ure-thral stenosis. Given the variable loading conditions inside the urethra, the proposed stent should maintain normal tissue kinetics and obstruct the narrowed lumen. The suitable selection for the stent material significantly influences the regeneration and proper remodeling of the urethral tissues. Methods: In this work, the mechanical characteristics of some polymer materials were studied, including: polydi-oxanone (PDO) and poly(L-lactide) (PLLA)/polycaprolactone (PCL) composite. The obtained mechanical properties for static tensile testing of the materials, allowed the determination of such parameters as Young\'s modulus (E), tensile strength (R m) and yield strength (R e). Subsequently, the design of a urological stent was developed, for which a numerical analysis was carried out to check the behaviour of the stent during varying loads prevailing in the urethra. Result: The research indicated that PDO has better mechanical properties than the proposed PLLA/PCL composite. The numerical analysis results suggested that the developed stent design can be successfully used in the treatment of male urethral stenosis. The obtained stress and strain distributions in the numerical analysis confirm that the PDO material can be used as a material for an urological stent. Conclusions: The biodegradable polymers can be successfully used in urology. Their advantages over solid materials are their physicochemical properties, the ability to manipulate the rate and time of degradation and the easy availability of materials and manufacturing technology.

There is increasing evidence that coronary artery wall shear stress (WSS) measurement provides useful prognostic information that allows prediction of adverse cardiovascular events. Computational Fluid Dynamics (CFD) has been extensively used in research to measure vessel physiology and examine the role of the local haemodynamic forces on the evolution of atherosclerosis. Nonetheless, CFD modelling remains computationally expensive and time-consuming, making its direct use in clinical practice inconvenient. A number of studies have investigated the use of deep learning (DL) approaches for fast WSS prediction. However, in these reports, patient data were limited and most of them used synthetic data generation methods for developing the training set. In this paper, we implement 2 approaches for synthetic data generation and combine their output with real patient data in order to train a DL model with a U-net architecture for prediction of WSS in the coronary arteries. The model achieved 6.03% Normalised Mean Absolute Error (NMAE) with inference taking only 0.35 s; making this solution time-efficient and clinically relevant.

OBJECTIVE: To explore the use of exam under anesthesia with vaginoscopy (EUA-V) following vaginoplasty in patients with congenital adrenal hyperplasia (CAH).
METHODS: Retrospective cohort METHODS: An IRB-approved retrospective chart review was performed of the post-surgical follow-up care of all patients diagnosed with classical CAH who sought care at a tertiary children\'s hospital from 2000-2017 and had undergone vaginoplasty at that institution.
RESULTS: Twenty-six patients met inclusion criteria. The median age at vaginoplasty was 1.25 years (IQR: 0.67, 9). Median post-surgical follow-up was 5.5 years (IQR: 1.5, 9). Twenty six EUA-Vs were performed, on 22 patients. Four were for complication assessment (rectovaginal fistula (1); urethrovaginal fistula (3)-on the same patient). The remaining 22 EUA-Vs, performed on 20 patients with two each undergoing two EUA-Vs, were planned for routine evaluation of vaginal patency. They were done a median of 0.67 years (IQR: 0.25, 2) following surgery and at a median of 6.67 years of age (IQR: 1.75, 12). Of these, five EUA-Vs identified stenosis in five patients (25%), a median of 0.91 years (IQR: 0.5, 7) after surgery, at a median age of 8.42 years (IQR: 2, 10.92). Of the four who did not undergo EUA-V, one had stenosis on clinical exam with ultrasound-verified hematocolpos. The remaining three were all prepubertal at last follow-up.
CONCLUSIONS: The majority of CAH patients following vaginoplasty underwent routine EUA-V, roughly a quarter of which detected stenosis. EUA-Vs may play a beneficial role in routine post-op care following vaginoplasty in patients with CAH.

BACKGROUND: The incidence of thrombosis in patients with intracranial atherosclerotic stenosis (ICAS) remains unclear. Optical coherence tomography (OCT) has the potential to explore the vessel wall structure of posterior-circulation ICAS because of its relatively straight anatomical structure compared with that of the anterior cerebral arteries. This study aimed to determine the prevalence and characteristics of thrombosis in the posterior-circulation ICAS using OCT.
METHODS: This prospective study was conducted on 135 patients with posterior-circulation arterial stenosis who underwent OCT. All patients were symptomatic and had a severely stenotic lesion (70-99%) in the vetebrobasilar artery. The enrolled patients were classified according to the presence of in situ thrombus as defined by OCT. Clinical data and OCT characteristics were compared.
RESULTS: Eighty-two patients diagnosed with posterior-circulation ICAS were enrolled. In situ thrombi were identified in 34 patients. Clinically, patients with in situ thrombus were more prone to cerebral infarctions than transient ischemic attacks. The percentage area of stenosis in the non-thrombus group was significantly lower than that in the thrombus group. The thrombus burden, mean flow area, mean thrombus area, maximum lipid arc, and mean lumen area were significantly different among white, red, and mixed thrombi.
CONCLUSIONS: We achieved in vivo vessel wall structural analysis of posterior-circulation ICAS with the largest sample size. We also revealed the true incidence of in situ thrombosis and potential corresponding clinical events of posterior-circulation ICAS for the first time.