Search

A 70-year-old man was referred to our hospital with a diagnosis of progressive increase in extravasation leading to an iatrogenic coronary artery (CA) pseudoaneurysm within a month of percutaneous coronary intervention (PCI). The pseudoaneurysm was located on the carina side of the proximal left descending artery (LAD) accompanied by peri-stent contrast staining around the left main trunk (LMT). After a shared decision-making process, a second PCI was performed to prevent CA pseudoaneurysm rupture owing to concerns of adhesion around the LMT and difficulty in approaching the carina side of the proximal LAD for surgery. Coil embolization with four coils was performed and kissing stents with two covered stents were implanted. After the "Double-D molding technique," intravascular ultrasound imaging revealed only small residual spaces out of the stents. Final coronary angiography (CAG) revealed no contrast staining of the pseudoaneurysm. Four months after the PCI, follow-up CAG revealed no further pseudoaneurysm enlargement. To the best of our knowledge, this is the first case of PCI for a CA pseudoaneurysm at the LMT bifurcation treated using kissing stents with two covered stents. Coil embolization and implantation of kissing stents with two covered stents with the "Double-D molding technique" is an optional method to stop further enlargement of the pseudoaneurysm at the left main trunk bifurcation. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the role of intravascular ultrasound (IVUS) for the technical assessment of kissing stents (KSs) and covered endovascular reconstruction of the aortic bifurcation (CERAB) in the treatment of aortoiliac obstructive disease involving the aortic bifurcation. We conducted a single-center retrospective review of patients undergoing endovascular treatment of severe aorto-iliac obstructive disease (2019-2023). IVUS was performed in patients treated by KSs or CERAB according to preoperative indications, in cases of moderate/severe calcifications, mural thrombus, total occlusions, and lesion extension towards the proximity of renal or hypogastric arteries. Indications for IVUS-guided intraoperative revisions were residual stenosis or compression >30%, incomplete stent-to-wall apposition, or flow-limiting dissection at the landing site. Follow-up assessment was performed at 6 and 12 months, and then yearly. Thirty-day outcomes and 2-year patency rates were evaluated. Logistic regression was used to identify factors associated with significant technical defects detected by IVUS needing intraoperative revision. IVUS was used for the technical assessment of 102 patients treated by KSs (n = 57; 56%) or CERAB (n = 45; 44%) presenting with severe intermittent claudication (39%), rest pain (39%), or ischemic tissue loss (25%). Twenty-nine significant technical defects were identified by IVUS in 25 patients (25%) who then had successful intraoperative correction by additional ballooning (n = 23; 80%) or stenting (n = 6; 20%). Patients with a severely calcified chronic total occlusion (odds ratio, 1.85; 95% confidence interval, 1.01-5.27; P =.044) or severely calcified narrow aortic bifurcation with <12 mm diameter (odds ratio, 2.34; 95% confidence interval, 1.10-8.64; P =.032) were at increased risk for IVUS-guided intraoperative revision. There were no postoperative deaths and no major adverse events. Two-year primary patency was 100%. IVUS was used for the technical assessment of KSs/CERAB in a selected cohort of patients with severe aorto-iliac obstructive disease. This allowed the identification and intraoperative correction of a significant technical defect not detected by completion angiogram in one-quarter of patients, achieving optimal 2-year results. IVUS assessment of KSs/CERAB may be considered especially in patients with a calcified total occlusion or narrow aortic bifurcation. [ABSTRACT FROM AUTHOR]

In this investigation, the analytical behavior of two prominent nonlinear wave equations, namely the doubly dispersive equation (DDE) and the Ablowitz-Kaup-Newell-Segur equation (AKNSE), have been scrutinized. Bifurcation analysis, sensitivity as well as chaotic phenomena are also performed for the earlier-mentioned dynamical systems. These analyzes have profuse applications in the field of electrical circuits and control systems, phase transitions in materials, climate patterns, chemical reaction networks, forecasting market trends, signal processing, and quantum mechanics. Using an advanced mathematical technique, the exact solutions of the mentioned two-wave equations with singular bell-shaped soliton, bell-shaped soliton, anti-bell-shaped soliton, singular soliton, and singular periodic soliton have been studied. The technique utilized in the study is dependable for solving complex nonlinear problems in various natural science and engineering disciplines employed by many researchers. This study identified ten general solutions and ten particular solutions for the two mentioned equations that are novel and precise wave solutions. The solutions obtained in our study are significant not only for understanding the mentioned field but also may be used in revealing other interesting phenomena, such as the analysis of seismology, the study of compulsive collapse, and the study of the material effects and inner construction of solids. [ABSTRACT FROM AUTHOR]

Early bifurcation of the common hepatic artery (EBCHA) is a rare anatomical variation (1%), that is often overlooked but can lead to accidental ligation of the right branch of the hepatic artery with consequent arterial ischemia of the right liver and potentially very serious complications during pancreaticoduodenectomy, partial hepatectomy, or liver harvesting for transplantation. It may be difficult to diagnose EBCHA using transverse imaging sections. However, on standard CT sections with intravenous contrast injection, three warning signs should allow the image reader to suspect it: presence of two hepatic arteries to the right of the celiac trunk, presence of a retro-portal hepatic artery, and absence of a right hepatic artery arising from the superior mesenteric artery. Analysis of the CT with reconstruction then allows for definitive diagnosis and limits the risk of accidental arterial injury or ligation. [ABSTRACT FROM AUTHOR]

• The ischemic peri-procedural complication rates of unruptured and ruptured aneurysm were 2.9% and 8.0% respectively. • The hemorrhagic peri-procedural complication rates of unruptured and ruptured aneurysm were 2.1% and 8.0% respectively. • Overall cumulative major recurrence rates at 12 months, 18 months, three years, and five years were correspondingly 5.1 %, 7.1 %, 11.9 %, and 11.9 %. • Independent risk factors for major recurrence were a ruptured aneurysm, initial imcomplete occlusion, aneurysm size, and neck size. To evaluate the feasibility and durability of coil embolization for MCAB aneurysms by analyzing clinical and radiological results. From January of 2008 to June of 2018, we treated a total of 1785 aneurysms using coil embolization. The aneurysms were treated by both coiling and stent-assisted coiling. Among these cases, 223 MCAB aneurysms were analyzed retrospectively. Clinical and radiological assessments were conducted at admission, after treatment, at discharge, and at last clinical follow-up. Coil embolization was performed on 223 MCAB aneurysms in 217 patients. Peri-procedural ischemic, hemorrhagic, and other complications within 30 days after coil embolization occurred at rates of 8.0 %, 8.0 %, and 2.0 %, respectively, in the ruptured group and at 2.9 %, 1.2 %, and 0 %, respectively, in the unruptured group. The overall morbidity and mortality rates associated with complications were 2.3 % and 2.0 %. The cumulative major recurrence rates were 5.1 % at 12 months, 7.1 % at 18 months, and 11.9 % at three years after coil embolization. The mean follow-up period was 33.27 ± 25.48 months. Independent risk factors for major recurrence after coil embolization for MCAB aneurysms were a ruptured aneurysm, initial incomplete occlusion, the aneurysm size, and the neck size. Coil embolization is a good alternative treatment option for MCAB aneurysms compared to surgical clipping. Considering the risk factors for major recurrence, the follow-up angiography should continue up to three years after coil embolization. [ABSTRACT FROM AUTHOR]

This study aims to assess the direct impact of bifurcation angle (BA) on immediate procedural outcomes and patient prognosis post-Nano-Crush stenting for coronary bifurcation lesions. A retrospective analysis was conducted for all consecutive patients treated with the Nano-Crush technique across two high-volume interventional centers from January 2020 to October 2022. Primary endpoint: comparison of target lesion failure rate in two cohorts based on bifurcation angle (<70° vs. ≥70°), with secondary endpoints including side branch ostium coverage, rate of successful final kissing balloon inflation (FKBI), need for conversion to another technique, and procedure length. Baseline demographics included 71 patients in the BA<70° group and 49 in the BA≥70° group, with well-balanced characteristics. Angiographic characteristics revealed similar trends, including anatomic and morphological lesion characteristics (referencing Syntax score, Medina classification, and presence of calcifications). Both groups predominantly had complex coronary disease, with a baseline mean Syntax score of 24.18 ± 8.19 in the BA<70° group and 23.91 ± 7.29 in the BA≥70° group, respectively. A dedicated debulking device for lesion preparation was used in 25.35 % of patients in the first group and in 28.57 % of patients in the second group. The primary endpoint occurred in 5.63 % of patients in the BA<70° group and in 4.08 % of patients in the BA≥70° group (P = 0.7014) after ≥ 2 years of clinical follow-up. Angiographic success was achieved in 100 % of both groups, with procedural time averaging 74.99 ± 25.55 min in the BA≥70° and 76.94 ± 27.81 min in the BA<70° (P = 0.6922). The rate of successful final kissing balloon inflation was 98.59 % in the BA<70° group and 95.91 % in the BA≥70° group (P = 0.3566). The mean contrast volume was 189.54 ± 73.74 ml in BA<70° and 168.9 ± 62.77 ml in BA≥70° (P = 0.1126). Clinical follow-ups at 30 days and 2 years revealed similar outcomes and complications for each group, as summarized in Table 3. Our results demonstrate that the bifurcation angle does not significantly impact long-term clinical outcomes or procedural parameters, such as side branch ostium coverage, conversion to a modified DK Crush technique, FKBI success rate, and procedure length. These findings suggest that the Nano-Crush technique can be a viable option for bifurcation lesions, irrespective of the bifurcation angle, achieving optimal side branch ostium coverage while preventing excessive protrusion into the main vessel. • Nano-Crush is theoretically more challenging in shallow-angle bifurcations. • A clinical trial assessed the impact of bifurcation angles on Nano-Crush technique outcomes. • Contrary to expectations, the bifurcation angle does not affect clinical outcomes or procedural parameters. • Bifurcation angle does not influence the branch ostium coverage, the FKBI success rate, or the procedure length. • The study also emphasized the importance of pre-dilatation and careful preparation of the main vessel and the side branch. [ABSTRACT FROM AUTHOR]

Unintended deformation of implanted coronary stents can lead to loss of coronary access, stent thrombosis and coronary events during follow-up. The incidence, mechanisms and clinical outcomes of unintended stent deformations (USD) during complex bifurcation stenting are not well characterized. In a prespecified analysis of the OCTOBER (European Trial on Optical Coherence Tomography Optimized Bifurcation Event Reduction) trial, we aimed to: 1) determine the incidence and characterize mechanisms of USD identified by optical coherence tomography (OCT); and 2) evaluate physician's detection and correction of accidental abluminal rewiring and USD. OCT scans were analyzed for accidental abluminal rewiring and USD. When USD was identified, the plausible mechanism was determined by analysis of all procedural OCT scans and the corresponding angiograms. USD was identified by the core lab in 9.3% (55/589) of OCT-guided cases. Accidental abluminal rewiring was the cause in 44% (24/55), and guide catheter collision was the cause in 40% (22/55) of cases. USD was found in 18.5% of all cases with left main bifurcation percutaneous coronary intervention. The total incidence of abluminal rewiring was 33 in 32 OCT-guided cases (5.4%) and was corrected by physicians in 18 of 33 appearances (54.5%). The 2-year major adverse cardiac event rate for patients with untreated USD (n = 30) was 23.3%, whereas patients with confirmed or possibly corrected USD (n = 25) had no events during follow-up. USD was associated with adverse procedural complications and cardiac events during follow-up when not identified and corrected. The predominant mechanisms were undetected abluminal rewiring and guide catheter collision. Left main bifurcation percutaneous coronary intervention was a particular risk with USD detected in 18.5% of cases. [Display omitted] [ABSTRACT FROM AUTHOR]

Detection of a low magnitude of chatter in micromilling process is not trivial attributed to non-dominance of the natural frequency; hence, bifurcation analysis has been proposed. Different thin-walled structures have been manufactured by carrying out the low radial immersion micromilling at radial depth of cuts of 30 µm to 130 µm in intervals of 25 µm and at cutting speeds of 20,000 rpm, 50,000 rpm and 80,000 rpm. The micromilling at low cutting speed 20,000 rpm showed circular nature of phase portrait diagram and hence, stability has been achieved. However, Flip (period-2) bifurcation has been detected at 50,000 rpm. Furthermore, increase of cutting speed to 80,000 rpm led to Hopf (Neimark-Sacker) bifurcation. The identified stability and instability based on bifurcation analysis have been used to validate the created stability lobe diagram for micromilling of thin-walled Ti6Al4V workpiece. Machined surface has also been analysed to validate the finding of bifurcation analysis. [ABSTRACT FROM AUTHOR]