114 results on '"Massimiliano M. Marrocco-Trischitta"'
Search Results
2. Carotid Phase-Contrast Magnetic Resonance before Treatment: 4D-Flow versus Standard 2D Imaging
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Francesco Secchi, Caterina Beatrice Monti, Davide Capra, Renato Vitale, Daniela Mazzaccaro, Michele Conti, Ning Jin, Daniel Giese, Giovanni Nano, Francesco Sardanelli, and Massimiliano M. Marrocco-Trischitta
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magnetic resonance imaging ,carotid stenosis ,endarterectomy ,carotid arteries ,randomized controlled trial ,phase-contrast magnetic resonance ,Computer applications to medicine. Medical informatics ,R858-859.7 - Abstract
The purpose of this study was to evaluate the level of agreement between flow/velocity data obtained from 2D-phase-contrast (PC) and 4D-flow in patients scheduled for treatment of carotid artery stenosis. Image acquisition was performed using a 1.5 T scanner. We compared mean flow rates, vessel areas, and peak velocities obtained during the acquisition with both techniques in 20 consecutive patients, 15 males and 5 females aged 69 ± 5 years (mean ± standard deviation). There was a good correlation between both techniques for the CCA flow (r = 0.65, p < 0.001), whereas for the ICA flow and ECA flow the correlation was only moderate (r = 0.4, p = 0.011 and r = 0.45, p = 0.003, respectively). Correlations of peak velocities between methods were good for CCA (r = 0.56, p < 0.001) and moderate for ECA (r = 0.41, p = 0.008). There was no correlation for ICA (r = 0.04, p = 0.805). Cross-sectional area values between methods showed no significant correlations for CCA (r = 0.18, p = 0.269), ICA (r = 0.1, p = 0.543), and ECA (r = 0.05, p = 0.767). Conclusion: the 4D-flow imaging provided a good correlation of CCA and a moderate correlation of ICA flow rates against 2D-PC, underestimating peak velocities and overestimating cross-sectional areas in all carotid segments.
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- 2021
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3. Tocilizumab for patients with COVID-19 pneumonia. The single-arm TOCIVID-19 prospective trial
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Francesco Perrone, Maria Carmela Piccirillo, Paolo Antonio Ascierto, Carlo Salvarani, Roberto Parrella, Anna Maria Marata, Patrizia Popoli, Laurenzia Ferraris, Massimiliano M. Marrocco-Trischitta, Diego Ripamonti, Francesca Binda, Paolo Bonfanti, Nicola Squillace, Francesco Castelli, Maria Lorenza Muiesan, Miriam Lichtner, Carlo Calzetti, Nicola Duccio Salerno, Luigi Atripaldi, Marco Cascella, Massimo Costantini, Giovanni Dolci, Nicola Cosimo Facciolongo, Fiorentino Fraganza, Marco Massari, Vincenzo Montesarchio, Cristina Mussini, Emanuele Alberto Negri, Gerardo Botti, Claudia Cardone, Piera Gargiulo, Adriano Gravina, Clorinda Schettino, Laura Arenare, Paolo Chiodini, Ciro Gallo, and the TOCIVID-19 investigators, Italy
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COVID-19 ,Pneumonia ,Coronavirus ,Tocilizumab ,IL-6 ,Phase 2 ,Medicine - Abstract
Abstract Background Tocilizumab blocks pro-inflammatory activity of interleukin-6 (IL-6), involved in pathogenesis of pneumonia the most frequent cause of death in COVID-19 patients. Methods A multicenter, single-arm, hypothesis-driven trial was planned, according to a phase 2 design, to study the effect of tocilizumab on lethality rates at 14 and 30 days (co-primary endpoints, a priori expected rates being 20 and 35%, respectively). A further prospective cohort of patients, consecutively enrolled after the first cohort was accomplished, was used as a secondary validation dataset. The two cohorts were evaluated jointly in an exploratory multivariable logistic regression model to assess prognostic variables on survival. Results In the primary intention-to-treat (ITT) phase 2 population, 180/301 (59.8%) subjects received tocilizumab, and 67 deaths were observed overall. Lethality rates were equal to 18.4% (97.5% CI: 13.6–24.0, P = 0.52) and 22.4% (97.5% CI: 17.2–28.3, P
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- 2020
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4. Psoas Cross-Sectional Measurements Using Manual CT Segmentation before and after Endovascular Aortic Repair (EVAR)
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Caterina Beatrice Monti, Paolo Righini, Maria Chiara Bonanno, Davide Capra, Daniela Mazzaccaro, Matteo Giannetta, Gabriele Maria Nicolino, Giovanni Nano, Francesco Sardanelli, Massimiliano M. Marrocco-Trischitta, and Francesco Secchi
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sarcopenia ,EVAR ,psoas muscle ,computed tomography ,Medicine - Abstract
Sarcopenia has been associated with an increased incidence of adverse outcomes, including higher mortality, after endovascular aortic repair (EVAR). We aim to use computed tomography (CT) to quantify changes in total psoas muscles area (PMA) and psoas muscle density (PMD) after EVAR, and to evaluate the reproducibility of both measurements. PMA and PMD were assessed via manual segmentation of the psoas muscle on pre- and post-operative CT scans belonging to consecutive patients who underwent EVAR. Wilcoxon test was used to compare PMA and PMD before and after EVAR, and inter- and intra-reader agreements of both methods were evaluated through Bland–Altman analysis. A total of 50 patients, 42 of them males (84%), were included in the study. PMA changes from 1243 mm2 (1006–1445 mm2) to 1102 mm2 (IQR 937–1331 mm2), after EVAR (p < 0.001). PMD did not vary between pre-EVAR (33 HU, IQR 26.5–38.7 HU) and post-EVAR (32 HU, IQR 26–37 HU, p = 0.630). At inter-reader Bland–Altman analysis, PMA showed a bias of 64.0 mm2 and a coefficient of repeatability (CoR) of 359.2 mm2, whereas PMD showed a bias of −2.43 HU and a CoR of 6.19 HU. At intra-reader Bland–Altman analysis, PMA showed a bias of −81.1 mm2 and a CoR of 394.6 mm2, whereas PMD showed a bias of 1.41 HU and a CoR of 6.36 HU. In conclusion, PMA decreases after EVAR. A good intra and inter-reader reproducibility was observed for both PMA and PMD. We thus propose to use PMA during the follow-up of patients who underwent EVAR to monitor muscle depletion after surgery.
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- 2022
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5. Sudden rupture of small aneurysm of the radial artery in a patient with COVID‐19 pneumonia
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Daniela Mazzaccaro, Matteo Giannetta, Giovanni Malacrida, Dino Zilio, Alfredo Modafferi, Paolo Righini, Massimiliano M. Marrocco‐Trischitta, Luca Vaienti, and Giovanni Nano
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aneurysm ,arterial rupture ,COVID‐19 ,radial artery ,radial catheter ,Medicine ,Medicine (General) ,R5-920 - Abstract
Abstract In patients with COVID‐19, even small radial aneurysm may suddenly rupture.
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- 2021
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6. Factors affecting the occurrence of proximal endoleak after endovascular abdominal aortic repair for abdominal aneurysms
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Daniela Mazzaccaro, Girolomina Mazzeo, Gianmarco Zuccon, Alfredo Modafferi, Giovanni Malacrida, Paolo C. Righini, Massimiliano M. Marrocco-Trischitta, and Giovanni Nano
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Medicine (General) ,R5-920 - Abstract
Objective This retrospective study was performed to assess the clinical and radiological variables associated with proximal type IA endoleak (EL) in patients treated with elective endovascular repair for abdominal aortic aneurysms. Methods The chi-square test, t-test, and logistic regression analysis were performed as appropriate. A P value of 20% significantly affected the occurrence of type IA EL. Conclusion When sizing endografts, a discrepancy was noted between the measurements of the diameter and area of the proximal neck. The area might represent a more accurate measurement than the axial diameter to optimize the proximal sealing and lower the risk of developing type IA EL.
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- 2020
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7. A Combined Deep Learning System for Automatic Detection of 'Bovine' Aortic Arch on Computed Tomography Scans
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Francesco Secchi, Matteo Interlenghi, Marco Alì, Elia Schiavon, Caterina Beatrice Monti, Davide Capra, Christian Salvatore, Isabella Castiglioni, Sergio Papa, Francesco Sardanelli, and Massimiliano M. Marrocco-Trischitta
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aorta ,thoracic ,brachiocephalic trunk ,carotid artery ,common ,deep learning ,Technology ,Engineering (General). Civil engineering (General) ,TA1-2040 ,Biology (General) ,QH301-705.5 ,Physics ,QC1-999 ,Chemistry ,QD1-999 - Abstract
The “bovine” aortic arch is an anatomic variant consisting in a common origin of the innominate and left carotid artery (CILCA), associated with a greater risk of thoracic aortic diseases (aneurysms and dissections), stroke, and complications after endovascular procedures. CILCA can be detected by visual assessment of computed tomography (CT) chest scans, but it is rarely reported. We developed a deep learning (DL) segmentation-plus-classification system to automatically detect CILCA based on 302 CT studies acquired at 2 centers. One model (3D U-Net) was trained from scratch (supervised by manual segmentation), validated, and tested for the automatic segmentation of the aortic arch and supra-aortic vessels. Three DL architectures (ResNet50, DenseNet-201, and SqueezeNet), pre-trained over millions of common images, were trained, validated, and tested for the automatic classification of CILCA versus non-CILCA, supervised by radiologist’s classification. The 3D U-Net-plus-DenseNet-201 was found to be the best system (Dice index 0.912); its classification performance obtained from internal, independent testing on 126 patients gave a receiver operating characteristic area under the curve of 87.0%, sensitivity 66.7%, specificity 90.5%, positive predictive value 87.5%, negative predictive value 73.1%, positive likelihood ratio 7.0, and negative likelihood ratio 0.4. In conclusion, a combined DL system applied to chest CT scans was developed and proven to be an effective tool to detect individuals with “bovine” aortic arch with a low rate of false-positive findings.
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- 2022
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8. Biomarkers Predict In-Hospital Major Adverse Cardiac Events in COVID-19 Patients: A Multicenter International Study
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Michael Y. Henein, Giulia Elena Mandoli, Maria Concetta Pastore, Nicolò Ghionzoli, Fouhad Hasson, Muhammad K. Nisar, Mohammed Islam, Francesco Bandera, Massimiliano M. Marrocco-Trischitta, Irene Baroni, Alessandro Malagoli, Luca Rossi, Andrea Biagi, Rodolfo Citro, Michele Ciccarelli, Angelo Silverio, Giulia Biagioni, Joseph A. Moutiris, Federico Vancheri, Giovanni Mazzola, Giulio Geraci, Liza Thomas, Mikhail Altman, John Pernow, Mona Ahmed, Ciro Santoro, Roberta Esposito, Guillem Casas, Rubén Fernández-Galera, Maribel Gonzalez, Jose Rodriguez Palomares, Ibadete Bytyçi, Frank Lloyd Dini, Paolo Cameli, Federico Franchi, Gani Bajraktari, Luigi Paolo Badano, and Matteo Cameli
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COVID-19 ,SARS-CoV2 ,biomarkers ,troponin ,creatinine ,prognosis ,Medicine - Abstract
Background: The COVID-19 pandemic carries a high burden of morbidity and mortality worldwide. We aimed to identify possible predictors of in-hospital major cardiovascular (CV) events in COVID-19. Methods: We retrospectively included patients hospitalized for COVID-19 from 10 centers. Clinical, biochemical, electrocardiographic, and imaging data at admission and medications were collected. Primary endpoint was a composite of in-hospital CV death, acute heart failure (AHF), acute myocarditis, arrhythmias, acute coronary syndromes (ACS), cardiocirculatory arrest, and pulmonary embolism (PE). Results: Of the 748 patients included, 141(19%) reached the set endpoint: 49 (7%) CV death, 15 (2%) acute myocarditis, 32 (4%) sustained-supraventricular or ventricular arrhythmias, 14 (2%) cardiocirculatory arrest, 8 (1%) ACS, 41 (5%) AHF, and 39 (5%) PE. Patients with CV events had higher age, body temperature, creatinine, high-sensitivity troponin, white blood cells, and platelet counts at admission and were more likely to have systemic hypertension, renal failure (creatinine ≥ 1.25 mg/dL), chronic obstructive pulmonary disease, atrial fibrillation, and cardiomyopathy. On univariate and multivariate analysis, troponin and renal failure were associated with the composite endpoint. Kaplan–Meier analysis showed a clear divergence of in-hospital composite event-free survival stratified according to median troponin value and the presence of renal failure (Log rank p < 0.001). Conclusions: Our findings, derived from a multicenter data collection study, suggest the routine use of biomarkers, such as cardiac troponin and serum creatinine, for in-hospital prediction of CV events in patients with COVID-19.
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- 2021
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9. Haemodynamic Crosstalk Between Carotid Arteries and Implications for Wall Shear Stress Measurements
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Michele Conti, Rodrigo M. Romarowski, Renato Vitale, Francesco Secchi, Giovanni Nano, and Massimiliano M. Marrocco-Trischitta
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 ,Surgery ,RD1-811 - Published
- 2020
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10. Non-Overt Coagulopathy in Non-ICU Patients with Mild to Moderate COVID-19 Pneumonia
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Daniela Mazzaccaro, Francesca Giacomazzi, Matteo Giannetta, Alberto Varriale, Rosa Scaramuzzo, Alfredo Modafferi, Giovanni Malacrida, Paolo Righini, Massimiliano M. Marrocco-Trischitta, and Giovanni Nano
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disseminated intravascular coagulation ,DIC ,COVID-19 ,respiratory distress ,Medicine - Abstract
Introduction: Aim of the study is to assess the occurrence of early stage coagulopathy and disseminated intravascular coagulation (DIC) in patients with mild to moderate respiratory distress secondary to SARS-CoV-2 infection. Materials and methods: Data of patients hospitalized from 18 March 2020 to 20 April 2020 were retrospectively reviewed. Two scores for the screening of coagulopathy (SIC and non-overt DIC scores) were calculated. The occurrence of thrombotic complication, death, and worsening respiratory function requiring non-invasive ventilation (NIV) or admission to ICU were recorded, and these outcomes were correlated with the results of each score. Chi-square test, receiver-operating characteristic curve, and logistic regression analysis were used as appropriate. p Values < 0.05 were considered statistically significant. Results: Data of 32 patients were analyzed. Overt-DIC was diagnosed in two patients (6.2%), while 26 (81.2%) met the criteria for non-overt DIC. Non-overt DIC score values ≥4 significantly correlated with the need of NIV/ICU (p = 0.02) and with the occurrence of thrombotic complications (p = 0.04). A score ≥4 was the optimal cut-off value, performing better than SIC score (p = 0.0018). Values ≥4 in patients with thrombotic complications were predictive of death (p = 0.03). Conclusions: Overt DIC occurred in 6.2% of non-ICU patients hospitalized for a mild to moderate COVID-19 respiratory distress, while 81.2% fulfilled the criteria for non-overt DIC. The non-overt DIC score performed better than the SIC score in predicting the need of NIV/ICU and the occurrence of thrombotic complications, as well as in predicting mortality in patients with thrombotic complications, with a score ≥4 being detected as the optimal cut-off.
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- 2020
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11. Vitamin D Deficiency Is Associated with Increased Osteocalcin Levels in Acute Aortic Dissection: A Pilot Study on Elderly Patients
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Elena Vianello, Elena Dozio, Alessandra Barassi, Lorenza Tacchini, John Lamont, Santi Trimarchi, Massimiliano M. Marrocco-Trischitta, and Massimiliano M. Corsi Romanelli
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Pathology ,RB1-214 - Abstract
An imbalance between degradation and reconstruction of the aortic wall is one of the leading causes of acute aortic dissection (AAD). Vitamin D seems an intriguing molecule to explore in the field of AAD since it improves endothelial function and protects smooth muscle cells from inflammation-induced remodeling, calcification, and loss of function, all events which are strongly related to the aging process. We quantified 25-hydroxy vitamin D, calcium, parathormone, bone alkaline phosphatase, and osteocalcin levels in 24 elderly AAD patients to identify a potential pathological implication of these molecules in AAD. Median 25-hydroxy vitamin D (10.75 ng/mL, 25th–75th percentiles: 6.86–19.23 ng/mL) and calcium levels (8.70 mg/dL, 25th–75th percentiles: 7.30–8.80 mg/dL) suggested hypovitaminosis D and a moderate hypocalcemia. Thirty-eight percent of AAD patients had severe (
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- 2017
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12. A Deep Learning-Based and Fully Automated Pipeline for Thoracic Aorta Geometric Analysis and Planning for Endovascular Repair from Computed Tomography.
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Simone Saitta, Francesco Sturla, Alessandro Caimi, Alessandra Riva, Maria Chiara Palumbo, Giovanni Nano, Emiliano Votta, Alessandro Della Corte, Mattia Glauber, Dante Chiappino, Massimiliano M. Marrocco-Trischitta, and Alberto Redaelli
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- 2022
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13. Computational simulation of TEVAR in the ascending aorta for optimal endograft selection: A patient-specific case study.
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Rodrigo Romarowski, Michele Conti, Simone Morganti, Viviana Grassi, Massimiliano M. Marrocco-Trischitta, Santi Trimarchi, and Ferdinando Auricchio
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- 2018
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14. Carotid Phase-Contrast Magnetic Resonance before Treatment: 4D-Flow versus Standard 2D Imaging
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Giovanni Nano, Caterina Beatrice Monti, Daniela Mazzaccaro, Francesco Sardanelli, Francesco Secchi, Renato Vitale, Ning Jin, Michele Conti, Davide Capra, Daniel Giese, and Massimiliano M. Marrocco-Trischitta
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Male ,Magnetic Resonance Spectroscopy ,Phase contrast microscopy ,Carotid arteries ,medicine.medical_treatment ,Computer applications to medicine. Medical informatics ,R858-859.7 ,Article ,Standard deviation ,law.invention ,Correlation ,phase-contrast magnetic resonance ,carotid arteries ,law ,Image Interpretation, Computer-Assisted ,medicine ,Humans ,Image acquisition ,magnetic resonance imaging ,Radiology, Nuclear Medicine and imaging ,Mean flow ,Aged ,Mathematics ,Endarterectomy ,endarterectomy ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,Middle Aged ,randomized controlled trial ,cardiovascular system ,carotid stenosis ,Female ,Nuclear medicine ,business ,Blood Flow Velocity - Abstract
The purpose of this study was to evaluate the level of agreement between flow/velocity data obtained from 2D-phase-contrast (PC) and 4D-flow in patients scheduled for treatment of carotid artery stenosis. Image acquisition was performed using a 1.5 T scanner. We compared mean flow rates, vessel areas, and peak velocities obtained during the acquisition with both techniques in 20 consecutive patients, 15 males and 5 females aged 69 ± 5 years (mean ± standard deviation). There was a good correlation between both techniques for the CCA flow (r = 0.65, p <, 0.001), whereas for the ICA flow and ECA flow the correlation was only moderate (r = 0.4, p = 0.011 and r = 0.45, p = 0.003, respectively). Correlations of peak velocities between methods were good for CCA (r = 0.56, p <, 0.001) and moderate for ECA (r = 0.41, p = 0.008). There was no correlation for ICA (r = 0.04, p = 0.805). Cross-sectional area values between methods showed no significant correlations for CCA (r = 0.18, p = 0.269), ICA (r = 0.1, p = 0.543), and ECA (r = 0.05, p = 0.767). Conclusion: the 4D-flow imaging provided a good correlation of CCA and a moderate correlation of ICA flow rates against 2D-PC, underestimating peak velocities and overestimating cross-sectional areas in all carotid segments.
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- 2021
15. Fast Approximate Quantification of Endovascular Stent Graft Displacement Forces in the Bovine Aortic Arch Variant
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Francesco Sturla, Alessandro Caimi, Rodrigo M. Romarowski, Giovanni Nano, Mattia Glauber, Alberto Redaelli, Emiliano Votta, and Massimiliano M. Marrocco-Trischitta
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thoracic aorta endovascular repair ,endovascular planning ,bovine aortic arch variant ,computational fluid dynamics ,displacement forces ,Radiology, Nuclear Medicine and imaging ,Surgery ,Cardiology and Cardiovascular Medicine ,Settore MED/22 - Chirurgia Vascolare - Abstract
Purpose: Displacement forces ( DFs) identify hostile landing zones for stent graft deployment in thoracic endovascular aortic repair (TEVAR). However, their use in TEVAR planning is hampered by the need for time-expensive computational fluid dynamics (CFD). We propose a novel fast-approximate computation of DFs merely exploiting aortic arch anatomy, as derived from the computed tomography (CT) and a measure of central aortic pressure. Materials and Methods: We tested the fast-approximate approach against CFD gold-standard in 34 subjects with the “bovine” aortic arch variant. For each dataset, a 3-dimensional (3D) model of the aortic arch lumen was reconstructed from computed tomography angiography and CFD then employed to compute DFs within the aortic proximal landing zones. To quantify fast-approximate DFs, the wall shear stress contribution to the DF was neglected and blood pressure space-distribution was averaged on the entire aortic wall to reliably approximate the patient-specific central blood pressure. Also, DF values were normalized on the corresponding proximal landing zone area to obtain the equivalent surface traction ( EST). Results: Fast-approximate approach consistently reflected (r2=0.99, pConclusion: Requiring only a few seconds and quantifying clinically relevant biomechanical parameters of proximal landing zones for arch TEVAR, our method suits the real preoperative decision-making process. It paves the way toward analyzing large population of patients and hence to define threshold values for a future patient-specific preoperative TEVAR planning.
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- 2022
16. Computational Fluid Dynamics Modeling of Proximal Landing Zones for Thoracic Endovascular Aortic Repair in the Bovine Arch Variant
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Mattia Glauber, Giovanni Nano, Moad Alaidroos, Massimiliano M. Marrocco-Trischitta, Rodrigo M. Romarowski, and Francesco Sturla
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Male ,Aortic arch ,Aortography ,Computed Tomography Angiography ,Pulsatile flow ,Hemodynamics ,Aorta, Thoracic ,030204 cardiovascular system & hematology ,030218 nuclear medicine & medical imaging ,Blood Vessel Prosthesis Implantation ,03 medical and health sciences ,0302 clinical medicine ,Blood vessel prosthesis ,medicine.artery ,medicine ,Humans ,Computer Simulation ,Arch ,Aged ,Retrospective Studies ,Computed tomography angiography ,Aged, 80 and over ,Aorta ,medicine.diagnostic_test ,business.industry ,Endovascular Procedures ,Models, Cardiovascular ,General Medicine ,Anatomy ,Blood Vessel Prosthesis ,Pulsatile Flow ,Hydrodynamics ,Female ,Surgery ,Stress, Mechanical ,Cardiology and Cardiovascular Medicine ,business - Abstract
To assess the endograft displacement forces (DF), which quantify the forces exerted by the pulsatile blood flow on the vessel wall and transmitted on the terminal fixation site of the endograft after its deployment in proximal landing zones (PLZs) of the bovine aortic arch variant.Thirty healthy aortic computed tomographic angiographies of subjects with bovine arch configuration (10 per type of arch, I-III) were selected for the purpose of the study. A 3-dimensional model of the aortic arch lumen was reconstructed. Computational fluid dynamics modeling was then used to compute DF magnitude and orientation (i.e., x, y, and z axes) in PLZs of each case. DF values were normalized to the corresponding aortic wall area to estimate equivalent surface traction (EST).DF were highest in zone 0, consistently with the greater surface area. DF in zone 3 were much greater than in zone 2 because of a 3-fold greater upward component (z axis) (P 0.001), being therefore mainly oriented orthogonally to the aortic blood flow and to the vessel longitudinal axis in that zone. EST progressively increased from zone 0 toward more distal PLZs, with EST in zone 3 being much greater than that in zone 2 (P 0.001). The same pattern was observed after stratification by type of arch.The bovine arch is associated with a consistent fluid dynamic pattern, which identifies in zone 3 an unfavorable biomechanical environment for endograft deployment.
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- 2020
17. Type III Arch Configuration as a Risk Factor for Carotid Artery Stenting: A Systematic Review of Contemporary Guidelines on Management of Carotid Artery Stenosis
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Irene Baroni, Giovanni Nava, Francesco Secchi, Giovanni Nano, Massimiliano M. Marrocco-Trischitta, and Renato Vitale
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Aortic arch ,medicine.medical_specialty ,Vascular Malformations ,Concordance ,MEDLINE ,Aorta, Thoracic ,030204 cardiovascular system & hematology ,Risk Assessment ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,medicine.artery ,medicine ,Humans ,Carotid Stenosis ,Clinical significance ,Risk factor ,business.industry ,General surgery ,Angioplasty ,General Medicine ,Evidence-based medicine ,medicine.disease ,Stroke ,Stenosis ,Treatment Outcome ,Systematic review ,Practice Guidelines as Topic ,Stents ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Type III arch configuration is frequently reported as a stroke risk factor for carotid angioplasty and stenting (CAS). We reviewed contemporary guidelines on management of carotid artery stenosis to assess the clinical relevance attributed to this anatomic feature in current clinical practice. Methods The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The PubMed, EMBASE, and Web of Science databases were searched to identify all guidelines on extracranial carotid disease published between January 2008 and March 2020. A total of 435 articles were screened. For multiple guidelines from the same writing group, only the most recent updated version was considered. Eighteen documents were identified for qualitative analysis. Results Four guidelines specifically reported type III arch as a predictive factor of periprocedural complications after CAS. Two of them also provided a low level of evidence of their recommendation. None of the documents indicated the exact criteria for aortic arch classification. Three different methods to describe type III arch configuration were identified. Conclusions Type III arch configuration is inconsistently included among stroke risk factors for CAS in contemporary guidelines, and variably defined. Further studies on the level of concordance between the 3 existing definition criteria are warranted.
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- 2020
18. COVID and venous thrombosis: systematic review of literature
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Daniela Mazzaccaro, Alfredo Modafferi, Massimiliano M. Marrocco-Trischitta, Fabiana Fancoli, Giovanni Nano, Matteo Giannetta, Paolo Righini, Valentina Milani, and Giovanni Malacrida
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medicine.medical_specialty ,MEDLINE ,Prevalence ,Disease ,Risk Assessment ,Asymptomatic ,Odds ,Fibrin Fibrinogen Degradation Products ,Sex Factors ,Risk Factors ,Internal medicine ,medicine ,Humans ,Obesity ,Blood Coagulation ,Venous Thrombosis ,business.industry ,Age Factors ,Anticoagulants ,COVID-19 ,General Medicine ,Prognosis ,medicine.disease ,Hospitalization ,Venous thrombosis ,Systematic review ,Surgery ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Biomarkers - Abstract
Introduction We aimed to review the prevalence, the risk factors and the outcomes of venous thrombosis (VT) in patients hospitalized for COronaVirus Disease 19 (COVID-19). Methods Electronic bibliographic databases were searched using the words "COVID venous thrombosis". The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement standards. Results The search of the Literature retrieved 877 results. After assessment of full texts, 69 papers were included in the qualitative analysis and 23 of them in the quantitative evaluation. The analyzed studies included a total of 106838 patients hospitalized for COVID-19 from 01/2020 to 12/2020. The pooled reported prevalence rate of VT was in median 16.7% (IQR 5.8%-30%), being higher in ICU patients (60.8%-85.4%). VT events were reported in about 75% of cases in the popliteal and calf veins. Signs and symptoms were present in 6.1% of cases. At quantitative evaluation, older age, D-dimer and obesity increased the odds to experience a VT (OR 3.54, 95%CI 0.65-6.43, P=0.01; OR=956.86, 95%CI 225.67-1668.05, P=0.01; OR 1.42, 95%CI 1.01-1.99, P=0.03 respectively). Female sex seemed to be protective against the odds of VT (OR 0.77, 95%CI 0.63-0.93, P=0.007). Conclusions Among patients hospitalized for COVID-19, VT is a relatively common finding, with higher prevalence rates in ICU patients. VT occurs mostly in the distal regions of the lower limb and is asymptomatic in most cases. Older age, obesity and higher D-dimer values on admission increased the odds of VT, while female sex was protective against the odds of VT.
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- 2022
19. Geometric Pattern of Proximal Landing Zones for Thoracic Endovascular Aortic Repair in the Bovine Arch Variant
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Paolo Righini, Rodrigo M. Romarowski, Massimiliano M. Marrocco-Trischitta, Giovanni Nano, Moad Alaidroos, Mattia Glauber, and Francesco Secchi
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Male ,Aortic arch ,Geometric pattern ,Computed Tomography Angiography ,Geometric configuration ,Bovine arch ,Aorta, Thoracic ,030204 cardiovascular system & hematology ,030230 surgery ,Aortic repair ,03 medical and health sciences ,0302 clinical medicine ,Aortic tortuosity ,medicine.artery ,medicine ,Humans ,Arch ,Brachiocephalic Trunk ,Aged ,Retrospective Studies ,business.industry ,Endovascular Procedures ,Anatomic Variation ,Middle Aged ,Carotid Arteries ,Female ,Surgery ,Cardiology and Cardiovascular Medicine ,Nuclear medicine ,business ,Relevant information - Abstract
The aim was to investigate whether the "bovine" aortic arch (i.e. arch variant with a common origin of the innominate and left carotid artery (CILCA)) is associated with a consistent geometric configuration of proximal landing zones for thoracic endovascular aortic repair (TEVAR).Anonymised thoracic computed tomography (CT) scans of healthy aortas were reviewed to retrieve 100 cases of CILCA. Suitable cases were stratified according to type 1 and 2 CILCA, and also based on type of arch (I, II, and III). Further processing allowed calculation of angulation and tortuosity of the proximal landing zones. Centre lumen line lengths of each proximal landing zone were measured in a view perpendicular to the centre line. All geometric features were compared with those measured in healthy patients with a standard arch configuration (n = 60). Two senior authors independently evaluated the CT scans, and intra- and interobserver repeatability were assessed.The 100 selected patients (63% male) were 71.4 ± 7.7 years old. Type 1 CILCA (62/100) was more prevalent than type 2 CILCA (38/100), and the two groups were comparable in age (p = .11). Zone 3 presented a severe angulation (i.e. 60°), which was greater than in Zone 2 (p .001), and a consistently greater tortuosity than Zone 2 (p = .003). This pattern did not differ between type 1 and type 2 CILCA. A greater tortuosity was also observed in Zone 0, which was related to increased elongation of the ascending aorta (i.e. Zone 0), than the standard configuration. The CILCA had an overall greater elongation, and Zone 2 also was specifically longer. When stratifying by type of arch, reversely from Type III to Type I, the CILCA presented a gradual flattening of its transverse tract, which entailed a consistent progressive elongation (p = .03) and kinking of the ascending aorta, with a significant increase of Zone 0 angulation to even a severe degree (p = .001). Also, from Type III to Type I, Zone 2 presented a progressively shorter length (p = .004), which was associated with increased tortuosity (p .05). Mean intra- and interobserver differences for angulation measurements were 1.4° ± 6.8° (p = .17) and 2.0° ± 10.1° (p = .19), respectively.CILCA presents a consistent and peculiar geometric pattern compared with standard arch configuration, which provides relevant information for TEVAR planning, and may have prognostic implications.
- Published
- 2020
20. Implications of different definitions for aortic arch classification provided by contemporary guidelines on thoracic aortic repair
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Massimiliano M. Marrocco-Trischitta and Mattia Glauber
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Pulmonary and Respiratory Medicine ,Aortic arch ,medicine.medical_specialty ,Carotid Artery, Common ,medicine.medical_treatment ,Concordance ,Aortic Diseases ,Aorta, Thoracic ,030204 cardiovascular system & hematology ,Aortic arches ,Aortic repair ,Blood Vessel Prosthesis Implantation ,03 medical and health sciences ,0302 clinical medicine ,Vascular ,medicine.artery ,medicine ,Humans ,Common carotid artery ,Thoracic aortic disease ,Retrospective Studies ,Aorta ,Aortic Aneurysm, Thoracic ,business.industry ,Endovascular Procedures ,Reproducibility of Results ,Treatment Outcome ,medicine.anatomical_structure ,030228 respiratory system ,cardiovascular system ,Stents ,Surgery ,Radiology ,Carotid stenting ,Cardiology and Cardiovascular Medicine ,business - Abstract
Contemporary guidelines on thoracic aortic repair provide inconsistent reporting standards for the definition of aortic arch classification in Types I, II and III. The different reported criteria cannot be used interchangeably, due to a very low level of concordance, and this finding has relevant implications for the comparisons between studies using different classifications, and between different datasets of multicentre trials, which are not consistently analyzed with the same criteria. Also, the reported definitions, which were originally proposed for predicting difficult carotid stenting and therefore were conceived for healthy aortic arches, can be influenced by the pathological derangements of the aortic wall, including aneurysms and dissections. In this respect, the Madhwal’s classification, which is based on the diameter of the left common carotid artery, appears to be the more suitable one for aortic arch classification in patients with thoracic aortic disease because it provides relevant clinical information along with an adequate reproducibility.
- Published
- 2021
21. Pre-admission acetylsalicylic acid therapy and impact on in-hospital outcome in COVID-19 patients: The ASA-CARE study
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Alberto Monello, Greta Comastri, Concetta Sticozzi, Alessandro Malagoli, Enrico Poletti, Alessia Zanni, Pasquale Vergara, Antonio Battista, Massimiliano M. Marrocco-Trischitta, Francesco Bandera, Andrea Biagi, Rosa Alessia Battista, Luca Rossi, Antonio Sisinni, Cosmo Godino, Marco Guazzi, Alberto Margonato, and Federica Battista
- Subjects
Male ,medicine.medical_specialty ,Multivariate analysis ,Coronavirus disease 2019 (COVID-19) ,Article ,Cohort Studies ,Internal medicine ,Platelet aggregation inhibitors ,Acetylsalicylic acid ,medicine ,Clinical endpoint ,Humans ,Hospital Mortality ,Aged ,Aspirin ,business.industry ,SARS-CoV-2 ,COVID-19 ,Thrombosis ,medicine.disease ,Hospitals ,Hospitalization ,Hospital outcomes ,Platelet aggregation inhibitor ,Cardiology and Cardiovascular Medicine ,business ,Cohort study ,medicine.drug - Abstract
Background Patients with coronavirus disease 2019 (COVID-19) exhibit high thrombotic risk. The evidence on a potential independent prognostic role of antiplatelet treatment in those patients is limited. The aim of the study was to evaluate the prognostic impact of pre-admission low-dose acetylsalicylic acid (ASA) in a wide series of hospitalized patients with COVID-19. Methods This cohort study included 984 COVID-19 patients stratified according to ASA intake before hospitalization: ASA+ (n = 253) and ASA− (n = 731). Patients were included in ASA+ group if they received it daily in the 7 days before admission. 213 (83%) were on ASA 100 mg daily. Primary endpoint was a composite of in-hospital death and/or need for respiratory support upgrade, secondary endpoints were in-hospital death and need for respiratory support upgrade. Results Mean age was 72 [62; 81] with 69% of male patients. ASA+ patients were significantly older, with higher prevalence of comorbidities. No significant differences regarding the degree of respiratory dysfunction were observed. At 30-day Kaplan-Meier analysis, ASA+ patients had higher survival free from the primary endpoint and need for respiratory support upgrade, conversely in-hospital death did not significantly differ between groups. At multivariate analysis ASA intake was independently associated with a lower probability of reaching primary endpoint (HR 0.697, 95% C.I. 0.525–0.924; p = 0.012). Conclusions In COVID-19 patients undergoing hospitalization, pre-admission treatment with ASA is associated with better in-hospital outcome, mainly driven by less respiratory support upgrade.
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- 2021
22. Sudden rupture of small aneurysm of the radial artery in a patient with COVID‐19 pneumonia
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Alfredo Modafferi, Giovanni Malacrida, Giovanni Nano, Dino Zilio, Massimiliano M. Marrocco-Trischitta, Daniela Mazzaccaro, Luca Vaienti, Matteo Giannetta, and Paolo Righini
- Subjects
Medicine (General) ,medicine.medical_specialty ,Case Report ,Case Reports ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Pseudoaneurysm ,R5-920 ,0302 clinical medicine ,Aneurysm ,COVID‐19 ,Ectasia ,medicine.artery ,medicine ,cardiovascular diseases ,Radial artery ,Respiratory distress ,business.industry ,General Medicine ,medicine.disease ,Surgery ,Pneumonia ,radial catheter ,medicine.anatomical_structure ,radial artery ,030220 oncology & carcinogenesis ,cardiovascular system ,aneurysm ,Medicine ,Arterial line ,business ,arterial rupture ,Artery - Abstract
In patients with COVID‐19, even small radial aneurysm may suddenly rupture.
- Published
- 2021
23. Blood Flow Helicity Pattern in Type III Arch Configuration as a Potential Risk Factor for Type B Aortic Dissection
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Moad Alaidroos, Giovanni Nano, Francesco Secchi, Rodrigo M. Romarowski, Massimiliano M. Marrocco-Trischitta, and Francesco Sturla
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medicine.medical_specialty ,Type B aortic dissection ,business.industry ,Potential risk ,Internal medicine ,medicine ,Cardiology ,Surgery ,Blood flow ,Arch ,Cardiology and Cardiovascular Medicine ,business ,Helicity - Published
- 2019
24. Prevalence of type III arch configuration in patients with type B aortic dissection
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Gabriele Piffaretti, Florian Schofer, Martin Czerny, Viony M. Belvroy, Hector W.L. de Beaufort, Jean Bismuth, Massimiliano M. Marrocco-Trischitta, Bartosz Rylski, Santi Trimarchi, and Francesco Secchi
- Subjects
Male ,Pulmonary and Respiratory Medicine ,Aortic arch ,medicine.medical_specialty ,Aorta, Thoracic ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Aneurysm ,medicine.artery ,Prevalence ,medicine ,Humans ,In patient ,Arch ,Risk factor ,Aged ,Retrospective Studies ,Aortic dissection ,Type III arch ,Aortic Aneurysm, Thoracic ,Type B aortic dissection ,business.industry ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,Aortic Dissection ,Standard error ,030228 respiratory system ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
OBJECTIVES Type III aortic arch configuration consistently presents anatomical and biomechanical characteristics which have been associated with an increased risk of type B aortic dissection (TBD). Our aim was to investigate the prevalence of type III arch in patients with TBD and type B intramural haematoma (IMH-B). METHODS A multicentre retrospective analysis was performed on patients with TBD and IMH-B observed between 2002 and 2017. The computed tomographic images were reviewed to identify the type of aortic arch. Exclusion criteria included previous arch surgery, presence of aortic dissection or aneurysm proximal to the left subclavian artery and bovine arches. An ad hoc systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to assess the prevalence of type III arch in non-TBD and non-aneurysmal patients. RESULTS Two hundred and sixty-one patients with TBD/IMH-B were found to be suitable for the study and were stratified according to aortic arch classification. The ad hoc literature search provided 10 relevant articles, from which a total of 7983 control cases were retrieved. TBD/IMH-B patients were significantly younger than controls [64.3, standard error: 0.74 (62.84–65.76) vs mean pooled age 70.5, standard error: 0.40 (69.71–71.28)]. Patients with TBD/IMH-B presented with a significantly higher prevalence of type III arch [41.0% (107/261) (35.2–47.1)] than controls [16% (1241/7983) (10–22)]. CONCLUSIONS Our data indicate an association between type III arch configuration and the occurrence of TBD/IMH-B. These findings warrant further studies to disclose the potential role of type III arch configuration as an anatomical risk factor for TBD/IMH-B.
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- 2019
25. Blood flow helical pattern in type III arch configuration as a potential risk factor for type B aortic dissection
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Massimiliano M, Marrocco-Trischitta and Francesco, Sturla
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Aortic Dissection ,Blood Vessel Prosthesis Implantation ,Aortic Aneurysm, Thoracic ,Risk Factors ,Endovascular Procedures ,Humans ,Aorta, Thoracic ,Stents ,Blood Vessel Prosthesis ,Retrospective Studies - Abstract
Abnormal helical flow (HF) in the aortic arch has been proposed as a causative factor for aortic dilatation and aortic dissections (ADs). Patients with type B AD present a high prevalence of type III arch configuration, which comprises recognized anatomic AD risk factors. Our aim was to assess whether the type III arch configures a consistent secondary HF pattern.We employed computational fluid dynamics to compare HF features associated with type I-III arches. The intra-aortic blood flow pattern was regionally assessed through the Modified Arch Landing Areas Nomenclature (MALAN) for planning endovascular aortic repair. Aortic flow pathlines were extracted from the systolic aortic velocity field and objectively characterized through intrinsic shape indices of absolute curvature |κ| and absolute torsion |τ|. Absolute local normalized helicity was computed and mapped on aortic flow pathlines.The tendency of aortic flow pathlines to bend and rotate exacerbated in the isthmus of type III arch (MALAN 3/III), where the highest |κ| values (P0.0001) were paralleled by the lowest |τ| values (P = 0.010), demonstrating the persistence of a high rotational HF heavily insisting on 3/III. In 3/III area, local normalized helicity was higher than both 3/I and 3/II (P = 0.053).Type III arch configuration is associated with a specific, consistent and abnormal secondary HF pattern, which may account for its high prevalence in patients with type B AD.
- Published
- 2021
26. Sudden rupture of small pseudoaneurysm of the radial artery in a patient with Covid-19 pneumonia
- Author
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Dino Zilio, Paolo Righini, Giovanni Malacrida, Giovanni Nano, Alfredo Modafferi, Massimiliano M. Marrocco-Trischitta, Daniela Mazzaccaro, Matteo Giannetta, and Luca Vaienti
- Subjects
Pneumonia ,Pseudoaneurysm ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,business.industry ,medicine.artery ,medicine ,Radiology ,Radial artery ,medicine.disease ,business - Abstract
We report the case of sudden rupture of a radial artery small pseudoaneurysm (PSA) occurring in a 63-years-old patient who had been hospitalized for COVID-19 pneumonia.
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- 2021
27. Impact of the coronavirus disease 2019 (COVID-19) pandemic on the care of patients with acute and chronic aortic conditions
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Alessandro Della Corte, Vitali A Sorokin, Mario D Oria, Arminder S. Jassar, Sandro Lepidi, Claudio Muneretto, Andreas Voetsch, Luca Di Marco, Claudio Corazzari, Chiara Lomazzi, Marwan Hamiko, Sven Peterss, J. Sirch, Andreas Zierer, Christian Hagl, K. Meisenbacher, Rodolfo Citro, Eric L.G. Verhoeven, Ernst Weigang, Maria Hugas-Mallorqui, Piotr Szopinski, C Probst, Athanasios Katsargyris, Maciej Kolowca, Xun Yuan, Michael Petrich, Antonio Micari, Severino Iesu, Alexander Hyhlik-Duerr, Massimiliano M. Marrocco-Trischitta, Frieda-Maria Kainz, Tim Walter, Corinna Walter, Bruno Schachner, Paul Puiu, Miriam Rychla, Jos C. van den Berg, Mariusz Kusmierczyk, Gabriele Ianelli, Thomas Schachner, Dittmar Böckler, Oyvind Jacobsen, Francesco Baldascino, Ivana Iesu, Philipp Discher, Martin Czerny, Jürg Schmidli, Kenji Minatoya, Martina Fink, Benedikt Reutersberg, Christopher De Troia, Christoph A. Nienaber, Koki Yokawa, Matthias Siepe, Thomas R Wyss, Filippo Gorgatti, Kay-Hyun Park, Ferdinand Vogt, Denise Galbiati, Oliver Y Bernecker, Luigi Di Tommaso, Peter L. Haldenwang, Ilenia D Alessio, Jai Ajitchandra Sule, Filippo Benedetto, Gabriele Piffaretti, Julia Dumfarth, Davide Pacini, Gabriel Weiss, Zoltán Szeberin, Andrzej Juraszek, Stephan Koter, Kazuhisa Sakamoto, Roman Gottardi, Fabrizio Rosati, Takayuki Shijo, Justus Strauch, Eduardo Bossone, Joon-Chui Jung, Yvonne Gosslau, Piotr Kołsut, Robin H. Heijmen, Antonio De Bellis, Santi Trimarchi, Giulio Accarino, Thomas Nolte, Eliza Pleban, Bartosz Rylski, Giovanni Nava, Florian Huber, Eva-Luca Tobler, Hector W.L. de Beaufort, Hitoshi Matsuda, Balazs Lengyel, Czerny, Martin, Gottardi, Roman, Puiu, Paul, Bernecker, Oliver Y, Citro, Rodolfo, Della Corte, Alessandro, di Marco, Luca, Fink, Martina, Gosslau, Yvonne, Haldenwang, Peter Luka, Heijmen, Robin H, Hugas-Mallorqui, Maria, Iesu, Severino, Jacobsen, Oyvind, Jassar, Arminder S, Juraszek, Andrzej, Kolowca, Maciej, Lepidi, Sandro, Marrocco-Trischitta, Massimiliano M, Matsuda, Hitoshi, Meisenbacher, Katrin, Micari, Antonio, Minatoya, Kenji, Park, Kay-Hyun, Peterss, Sven, Petrich, Michael, Piffaretti, Gabriele, Probst, Chri, Reutersberg, Benedikt, Rosati, Fabrizio, Schachner, Bruno, Schachner, Thoma, Sorokin, Vitali A, Szeberin, Zoltan, Szopinski, Piotr, Di Tommaso, Luigi, Trimarchi, Santi, Verhoeven, Eric L G, Vogt, Ferdinand, Voetsch, Andrea, Walter, Tim, Weiss, Gabriel, Yuan, Xun, Benedetto, Filippo, De Bellis, Antonio, D Oria, Mario, Discher, Philipp, Zierer, Andrea, Rylski, Bartosz, van den Berg, Jos C, Wyss, Thomas R, Bossone, Eduardo, Schmidli, Jürg, Nienaber, Christoph, Accarino, Giulio, Baldascino, Francesco, Böckler, Dittmar, Corazzari, Claudio, D Alessio, Ilenia, de Beaufort, Hector, De Troia, Christopher, Dumfarth, Julia, Galbiati, Denise, Gorgatti, Filippo, Hagl, Christian, Hamiko, Marwan, Huber, Florian, Hyhlik-Duerr, Alexander, Ianelli, Gabriele, Iesu, Ivana, Jung, Joon-Chui, Kainz, Frieda-Maria, Katsargyris, Athanasio, Koter, Stephan, Kusmierczyk, Mariusz, Kolsut, Piotr, Lengyel, Balaz, Lomazzi, Chiara, Muneretto, Claudio, Nava, Giovanni, Nolte, Thoma, Pacini, Davide, Pleban, Eliza, Rychla, Miriam, Sakamoto, Kazuhisa, Shijo, Takayuki, Yokawa, Koki, Siepe, Matthia, Sirch, Joachim, Strauch, Justu, Sule, Jai Ajitchandra, Tobler, Eva-Luca, Walter, Corinna, Weigang, Ernst, Y Bernecker, Oliver, Lukas Haldenwang, Peter, H Heijmen, Robin, S Jassar, Arminder, M Marrocco-Trischitta, Massimiliano, A Sorokin, Vitaly, G Verhoeven, Eric L, D'Oria, Mario, C van den Berg, Jo, R Wyss, Thoma, D´ Alessio, Ilenia, and Ajitchandra Sule, Jai
- Subjects
Coronavirus disease 2019 pandemic ,Surgical volume ,Acute and elective thoracic and abdominal aortic procedures ,030204 cardiovascular system & hematology ,Acute and elective thoracic and abdominal aortic procedure ,0302 clinical medicine ,Pandemic ,030212 general & internal medicine ,610 Medicine & health ,Acute aortic syndrome ,AcademicSubjects/MED00920 ,General Medicine ,Coronavirus disease ,Europe ,medicine.anatomical_structure ,Italy ,Elective Surgical Procedures ,Original Article ,Cardiology and Cardiovascular Medicine ,Aortic surgery ,Switzerland ,Human ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,2019 pandemic ,Asia ,Coronavirus disease 2019 (COVID-19) ,Referral ,Thoracic aorta ,03 medical and health sciences ,Acute onset ,medicine.artery ,Internal medicine ,medicine ,Humans ,ddc:610 ,Pandemics ,Aorta ,Elective Surgical Procedure ,business.industry ,SARS-CoV-2 ,COVID-19 ,The Netherlands ,medicine.disease ,Confidence interval ,Abdomen ,Surgery ,business - Abstract
OBJECTIVES The aim of this study was to evaluate the effects of the coronavirus 2019 pandemic on elective and acute thoracic aortic surgery in the Netherlands. METHODS The Netherlands Heart Registration database was used to compare the volume of elective and acute surgery on the thoracic aorta in 2019 and 2020, starting from week 11 in both years. A sub-analysis was done to assess the impact of the pandemic on high-volume and low-volume aortic centres. RESULTS During the pandemic, the number of elective thoracic aortic operations declined by 18% [incidence rate ratio (IRR) 0.82 [0.73–0.91]; P < 0.01]. The decline in volume of elective surgery was significant in both high-volume (IRR 0.82 [0.71–0.94]; P < 0.01) and low-volume aortic centres (IRR 0.81 [0.68–0.98]; P = 0.03). The overall number of acute aortic operations during the pandemic remained similar to that in 2019 (505 vs 499; P = 0.85), but an increased share of these operations occurred at high-volume centres. The number of acute operations performed in high-volume centres increased by 20% (IRR 1.20 [1.01–1.42]; P = 0.04), while the number of acute operations performed in low-volume centres decreased by 17% (IRR 0.83 [0.69–1.00]; P = 0.04). CONCLUSIONS The coronavirus 2019 pandemic led to a significant decrease in elective thoracic aortic surgery but did not cause a change in the volume of acute thoracic aortic surgery in the Netherlands. Moreover, the pandemic led to a centralization of care for acute thoracic aortic surgery., The coronavirus disease 19 (COVID-19) pandemic has impacted the delivery of health care around the world.
- Published
- 2021
28. Corrigendum to 'Impact of the coronavirus disease 2019 (COVID-19) pandemic on the care of patients with acute and chronic aortic conditions'
- Author
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K. Meisenbacher, Luigi Di Tommaso, Peter L. Haldenwang, Eliza Pleban, Benedikt Reutersberg, Christopher De Troia, Christoph A. Nienaber, Josua Cornelis Van den Berg, Sven Peterss, Jürg Schmidli, Matthias Siepe, Davide Pacini, Filippo Gorgatti, Paul Puiu, Denise Galbiati, Oyvind Jacobsen, Gabriele Piffaretti, Julia Dumfarth, Yvonne Gosslau, C Probst, Athanasios Katsargyris, Piotr Kołsut, Kay-Hyun Park, Francesco Baldascino, Antonio Micari, Rodolfo Citro, Ernst Weigang, Maria Hugas-Mallorqui, Claudio Corazzari, Tim Walter, Andreas Zierer, Corinna Walter, Marwan Hamiko, Mariusz Kusmierczyk, Michael Petrich, Severino Iesu, Vitaly Sorokin, Zoltán Szeberin, Kenji Minatoya, Alessandro Della Corte, Gabriel Weiss, Philipp Discher, Martina Fink, Stephan Koter, Piotr Szopinski, Ivana Iesu, Roman Gottardi, Fabrizio Rosati, Arminder S. Jassar, Sandro Lepidi, Alexander Hyhlik-Duerr, Justus Strauch, Dittmar Böckler, Claudio Muneretto, Andreas Voetsch, Kazuhisa Sakamoto, Jai Ajitchandra Sule, Thomas Nolte, Giovanni Nava, Takayuki Shijo, Joon-Chui Jung, Gabriele Ianelli, Thomas Schachner, Christian Hagl, Filippo Benedetto, Xun Yuan, Bruno Schachner, Andrzej Juraszek, Robin H. Heijmen, Antonio De Bellis, Chiara Lomazzi, Eduardo Bossone, Massimiliano M. Marrocco-Trischitta, Eric L.G. Verhoeven, Miriam Rychla, Santi Trimarchi, Giulio Accarino, Frieda-Maria Kainz, Luca Di Marco, J. Sirch, Maciej Kolowca, Florian Huber, Eva-Luca Tobler, Hector W.L. de Beaufort, Hitoshi Matsuda, Balazs Lengyel, Ilenia D'Alessio, Bartosz Rylski, Oliver Y Bernecker, Koki Yokawa, Martin Czerny, Mario D'Oria, Thomas R Wyss, and Ferdinand Vogt
- Subjects
Pulmonary and Respiratory Medicine ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,AcademicSubjects/MED00920 ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,General Medicine ,Virology ,Pandemic ,Medicine ,Surgery ,Corrigendum ,Cardiology and Cardiovascular Medicine ,business ,610 Medizin und Gesundheit - Published
- 2021
- Full Text
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29. OUP accepted manuscript
- Author
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Francesco Sturla and Massimiliano M. Marrocco-Trischitta
- Subjects
Pulmonary and Respiratory Medicine ,Aortic arch ,medicine.medical_specialty ,Type B aortic dissection ,Potential risk ,business.industry ,General Medicine ,Blood flow ,Aortic repair ,medicine.artery ,Internal medicine ,Cardiology ,medicine ,Surgery ,In patient ,Arch ,Cardiology and Cardiovascular Medicine ,business ,Helical flow - Abstract
OBJECTIVES Abnormal helical flow (HF) in the aortic arch has been proposed as a causative factor for aortic dilatation and aortic dissections (ADs). Patients with type B AD present a high prevalence of type III arch configuration, which comprises recognized anatomic AD risk factors. Our aim was to assess whether the type III arch configures a consistent secondary HF pattern. METHODS We employed computational fluid dynamics to compare HF features associated with type I-III arches. The intra-aortic blood flow pattern was regionally assessed through the Modified Arch Landing Areas Nomenclature (MALAN) for planning endovascular aortic repair. Aortic flow pathlines were extracted from the systolic aortic velocity field and objectively characterized through intrinsic shape indices of absolute curvature |κ| and absolute torsion |τ|. Absolute local normalized helicity was computed and mapped on aortic flow pathlines. RESULTS The tendency of aortic flow pathlines to bend and rotate exacerbated in the isthmus of type III arch (MALAN 3/III), where the highest |κ| values (P < 0.0001) were paralleled by the lowest |τ| values (P = 0.010), demonstrating the persistence of a high rotational HF heavily insisting on 3/III. In 3/III area, local normalized helicity was higher than both 3/I and 3/II (P = 0.053). CONCLUSIONS Type III arch configuration is associated with a specific, consistent and abnormal secondary HF pattern, which may account for its high prevalence in patients with type B AD.
- Published
- 2021
30. Determinants of preoperative decision-making process for cirrhotic patients with infrarenal aortic aneurysm
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Massimiliano M. Marrocco-Trischitta
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Liver Cirrhosis ,medicine.medical_specialty ,business.industry ,General surgery ,MEDLINE ,medicine.disease ,Aortic Aneurysm ,Blood Vessel Prosthesis Implantation ,Aortic aneurysm ,Text mining ,medicine ,Humans ,Surgery ,Decision-making ,Cardiology and Cardiovascular Medicine ,business ,Aortic Aneurysm, Abdominal ,Abdominal surgery - Published
- 2021
31. Re 'Leaving Behind Excess Aortic Neck in Open AAA Repair: To Be Avoided?'
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Massimiliano M. Marrocco-Trischitta
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medicine.medical_specialty ,Blood Vessel Prosthesis Implantation ,Text mining ,business.industry ,medicine ,Humans ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Aortic neck ,Aorta ,Aortic Aneurysm, Abdominal - Published
- 2020
32. Poor concordance between definitions of type III arch and implications for risk prediction and assessment for carotid artery stenting
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Sara Boveri, Giovanni Nano, Renato Vitale, Massimiliano M. Marrocco-Trischitta, Francesco Secchi, Giovanni Nava, and Irene Baroni
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Carotid Artery Diseases ,Male ,Computed Tomography Angiography ,Vascular Malformations ,Concordance ,Carotid arteries ,Clinical Decision-Making ,Aorta, Thoracic ,030204 cardiovascular system & hematology ,Aortography ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Risk Factors ,medicine.artery ,Medicine ,Humans ,Clinical significance ,030212 general & internal medicine ,Common carotid artery ,Risk factor ,Arch ,Stroke ,Aged ,Retrospective Studies ,Aged, 80 and over ,Observer Variation ,business.industry ,Endovascular Procedures ,Reproducibility of Results ,medicine.disease ,Confidence interval ,Surgery ,Female ,Stents ,Anatomic Landmarks ,Cardiology and Cardiovascular Medicine ,business ,Nuclear medicine - Abstract
OBJECTIVE The type III arch configuration has been inconsistently reported as a stroke risk factor during carotid artery stenting. However, at least three different methods for the definition of type III arch can be identified in the literature, related to the level of the origin of the innominate artery (IA). According to Casserly's definition, a type III arch presents with an origin of the IA below the horizontal plane of the inner curvature. According to Madhwal's definition, a type III arch has a distance greater than twice the diameter of the left common carotid artery between the highest point of the arch and the origin of the IA. According to MacDonald's definition, a type III arch presents with a distance of ≥2 cm between the highest point of the arch and the origin of the IA. Our aim was to assess the level of concordance between these different methods. METHODS Anonymized thoracic computed tomography scans of 100 healthy patients were reviewed. Two of us independently stratified the selected cases as a type I to III arch, according to the three considered definitions. The interobserver level of concordance for each type III arch classification and level of concordance among the three definitions were assessed. RESULTS The 100 selected patients (64% male) were 76 ± 7 years old. For each definition, the interobserver repeatability was almost perfect for all three (Madhwal, κ = 0.81; 95% confidence interval [CI], 0.71-0.99; MacDonald, κ = 0.82; 95% CI, 0.72-0.92; Casserly, κ = 0.84; 95% CI, 0.74-0.93). The level of concordance among the different definitions was very low (Madhwal vs MacDonald, 85% [P = .002]; 33% for type III arch; Madhwal vs Casserly, 60% [P < .0001]; 12% for type III arch; MacDonald vs Casserly, 75% [P < .0001]; 12% for type III arch). CONCLUSIONS The three definitions of the type III arch have a very low level of concordance, which might account for the varying clinical relevance of this configuration. Our findings have relevant implications for risk prediction for carotid artery stenting based on the presence of a type III arch, for comparisons of the results from different studies, and for comparisons of different datasets from multicenter trials.
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- 2020
33. Assessing QT interval in COVID-19 patients:safety of hydroxychloroquine-azithromycin combination regimen
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Massimiliano M. Marrocco-Trischitta, Valerio Mecarocci, Ewa Witkowska, Andrea Bernardini, Carlo Pappone, Francesca Santini, Serenella Castelvecchio, Roberto Rondine, Emanuela T. Locati, Gabriele Vicedomini, Carlo de Innocentiis, Lorenzo Menicanti, Giuseppe Ciconte, Gabriele Negro, Tommaso Viva, Luigi Giannelli, Bernardini, A., Ciconte, G., Negro, G., Rondine, R., Mecarocci, V., Viva, T., Santini, F., de Innocentiis, C., Giannelli, L., Witkowska, E., Locati, E. T., Castelvecchio, S., Marrocco-Trischitta, M. M., Vicedomini, G., Menicanti, L., and Pappone, C.
- Subjects
QT interval ,Male ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Combination therapy ,Population ,030204 cardiovascular system & hematology ,Azithromycin ,Article ,03 medical and health sciences ,Antimalarials ,Electrocardiography ,0302 clinical medicine ,Age ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,education ,Aged ,Retrospective Studies ,Aged, 80 and over ,education.field_of_study ,business.industry ,ECG ,COVID-19 ,Retrospective cohort study ,Hydroxychloroquine ,Middle Aged ,Anti-Bacterial Agents ,Regimen ,Long QT Syndrome ,Drug Therapy, Combination ,Female ,Patient Safety ,business ,Cardiology and Cardiovascular Medicine ,medicine.drug ,Follow-Up Studies - Abstract
Background Hydroxychloroquine (HCQ) and azithromycin (AZT) have been proposed for COVID-19 treatment. Data available in the literature reported a potential increased risk of fatal arrhythmias under these therapies. The aim of this study was to assess the effects of these drugs on QT interval and outcome in a COVID-19 population. Methods A total of 112 consecutive COVID-19 patients were included in this analysis and were divided in 3 groups according to the receiving therapeutic regimens: 19 (17%) patients in Group 1 (no treatment), 40 (36%) in Group 2 (HCQ only), 53 (47%) in Group 3 (HCQ/AZT). Results A prolonged QTc interval was found in 61% of patients treated with HCQ alone or in combination with AZT, but only 4 (4%) patients showed a QTc > 500 ms. HCQ/AZT combination determined a greater increase of QTc duration compared to the other two strategies (Group 3452 ± 26.4 vs Group 2436.3 ± 28.4 vs Group 1424.4 ± 24.3 ms, respectively; p, Highlights • Only the use of HCQ in combination with AZT causes a significant increase of QT interval. • Older patients are at higher risk of prolonged QT when treated with HCQ with/without AZT. • The use of HCQ alone or in combination with AZT might be considered as safe relating to arrhythmic risk in the treatment of COVID-19 patients.
- Published
- 2020
34. Aortic arch variant with a common origin of the innominate and left carotid artery as a determinant of thoracic aortic disease: a systematic review and meta-analysis
- Author
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Valentina Milani, Rodrigo M. Romarowski, Giovanni Nano, Moad Alaidroos, Federico Ambrogi, Massimiliano M. Marrocco-Trischitta, Mattia Glauber, and Francesco Secchi
- Subjects
Carotid Artery Diseases ,Pulmonary and Respiratory Medicine ,Aortic arch ,medicine.medical_specialty ,Carotid Artery, Common ,business.industry ,Aortic Diseases ,Aorta, Thoracic ,General Medicine ,Publication bias ,Odds ratio ,Confidence interval ,Systematic review ,Thoracic Diseases ,Meta-analysis ,medicine.artery ,Internal medicine ,Cardiology ,medicine ,Humans ,Surgery ,Arch ,Thoracic aortic disease ,Cardiology and Cardiovascular Medicine ,business - Abstract
The aim of this study was to investigate whether the ‘bovine’ arch [i.e. arch variant with a common origin of the innominate and left carotid artery (CILCA)] is associated with an increased risk of thoracic aortic disease (TAD). The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The PubMed, EMBASE and Cochrane databases were searched to identify all case series reporting about CILCA arch and TAD between January 2008 and December 2018. A total of 485 studies were screened. The prevalence of CILCA arch was assessed, and data analysis was performed considering the difference in the risk of TAD for presence versus absence of CILCA arch. Eight studies enrolling 11 381 subjects were retrieved for quantitative analysis. The proportion of TAD among CILCA arch patients was higher [41.5% (28.1–56.4)] than the proportion among patients with standard arch configuration 34.0% (20.1–51.4). The odds ratio of developing TAD was 1.4 times higher in subjects with CILCA arch (95% confidence interval 1.068–1.839). The test for an overall effect indicated a significant association between CILCA arch and TAD (P
- Published
- 2019
35. Blood Flow after Endovascular Repair in the Aortic Arch: A Computational Analysis
- Author
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Hector W.L. de Beaufort, Rodrigo M. Romarowski, Ferdinando Auricchio, Simone Morganti, Frans L. Moll, Santi Trimarchi, Theodorus M. J. van Bakel, Francesco Secchi, Joost A. van Herwaarden, Massimiliano M. Marrocco-Trischitta, and Michele Conti
- Subjects
Aortic arch ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Maximum flow problem ,Hemodynamics ,Stent ,Blood flow ,thoracic endovascular aortic repair ,medicine.artery ,Angiography ,medicine ,blood flow ,Thoracic aorta ,Original Article ,displacement force ,Radiology, Nuclear Medicine and imaging ,Surgery ,Common carotid artery ,Cardiology and Cardiovascular Medicine ,business ,Nuclear medicine - Abstract
Background The benefits of thoracic endovascular aortic repair (TEVAR) have encouraged stent graft deployment more proximally in the aortic arch. This study quantifies the hemodynamic impact of TEVAR in proximal landing zone 2 on the thoracic aorta and the proximal supra-aortic branches. Methods Patients treated with TEVAR in proximal landing zone 2 having available preoperative and 30-day postoperative computer tomography angiography and phase-contrast magnetic resonance imaging data were retrospectively selected. Blood flow was studied using patient-specific computational fluid dynamics simulations. Results Four patients were included. Following TEVAR in proximal landing zone 2, the mean flow in the left common carotid artery (LCCA) increased almost threefold, from 0.21 (0.12–0.41) L/min to 0.61 (0.24–1.08) L/min (+294%). The surface area of the LCCA had not yet increased commensurately and therefore maximum flow velocity in the LCCA increased from 44.9 (27.0–89.3) cm/s to 72.6 (40.8–135.0) cm/s (+62%). One of the patients presented with Type Ib endoleak at 1-year follow-up. The displacement force in this patient measured 32.1 N and was directed dorsocranial, perpendicular to the distal sealing zone. There was a linear correlation between the surface area of the stent graft and the resulting displacement force (p = 0.04). Conclusion TEVAR in proximal landing zone 2 alters blood flow in the supra-aortic branches, resulting in increased flow with high flow velocities in the LCCA. High displacement forces were calculated and related to stent graft migration and Type I endoleak during 1-year follow-up.
- Published
- 2018
36. Status of branched endovascular aortic arch repair
- Author
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Santi Trimarchi, Massimiliano M. Marrocco-Trischitta, Frans L. Moll, Jean Bismuth, Himanshu J. Patel, Theodorus M. J. van Bakel, Hector W.L. de Beaufort, and Joost A. van Herwaarden
- Subjects
Aortic arch ,medicine.medical_specialty ,Medical device ,business.industry ,030204 cardiovascular system & hematology ,medicine.disease ,Aortic repair ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,medicine.artery ,Perspective ,medicine ,In patient ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business ,Stroke - Abstract
Multiple medical device manufacturers are developing branched endografts for thoracic endovascular aortic repair (TEVAR), to provide a minimally invasive alternative for the treatment of aortic arch pathologies in patients who are deemed unfit for open or hybrid arch repair. Different branched endografts have been introduced, with varying number, size and orientation of the branches that redirect flow to the supra-aortic arteries. We present an overview of the currently investigated devices and review their outcomes. The results of branched TEVAR are promising, yet stroke remains the predominant periprocedural concern. For now, these procedures should be limited to select expert centers where the design and deployment procedure of branched endografts can be further developed to reduce the risk of stroke.
- Published
- 2018
37. Thoracic Endovascular Aortic Repair for Type B Acute Aortic Dissection Complicated by Descending Thoracic Aneurysm
- Author
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Patrizio Castelli, Fiore Ferilli, Santi Trimarchi, Raimondo Micheli, Massimiliano M. Marrocco-Trischitta, Gabriele Piffaretti, Marco Franchin, Chiara Lomazzi, Paolo Ottavi, and Walter Dorigo
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,Aneurysm ,Complicated type B acute aortic dissection ,Computed Tomography Angiography ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,Aortography ,Thoracic aortic aneurysm ,Disease-Free Survival ,Blood Vessel Prosthesis Implantation ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine.artery ,medicine ,Humans ,Thoracic aorta ,Aged ,Retrospective Studies ,Computed tomography angiography ,Aortic dissection ,Aorta ,Framingham Risk Score ,Aortic Aneurysm, Thoracic ,medicine.diagnostic_test ,business.industry ,Endovascular Procedures ,Middle Aged ,medicine.disease ,Surgery ,Aortic Dissection ,Treatment Outcome ,Italy ,030228 respiratory system ,Acute Disease ,cardiovascular system ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,Complication ,business - Abstract
Objectives To analyse the results and review the literature about thoracic aortic endovascular repair (TEVAR) for type B acute aortic dissection (TBAAD) complicated by descending thoracic aortic aneurysm (DTA) in the hyperacute or acute phases. Methods This was a multicentre, observational descriptive study. Inclusion criteria were TBAAD with a DTA of ≥50 mm, TBAAD on an already known aneurysmal descending thoracic aorta, and TBAAD presenting with an enlarged aorta with a total diameter 50% diameter increase compared with a previous computed tomography angiography (CTA) showing a non-dissected aorta with normal sizing. Primary endpoints were early and long-term survival, freedom from TEVAR and aortic related mortality (ARM), and freedom from re-intervention. Results Twenty-two patients were included in the analysis. The mean aortic diameter was 66 ± 26 mm (range 42–130; IQR 51–64). The in hospital TEVAR related mortality was 14% ( n = 3). The mean radiological follow-up was 56 ± 45 months (range 6–149; IQR 12–82), and the follow-up index 0.97 ± 0.1. All surviving patients were available for follow-up. During follow-up the cumulative mortality was 26% ( n = 5) and TEVAR related mortality was 5% (n = 1). Overall the estimate of survival was 82% (95%CI: 61.5–93) at 1 year, and 64% at 5 years. Ongoing primary clinical success was 79% (re-intervention n = 4). Freedom from aortic related mortality was 86% (95%CI: 66–95) at 1 and 5 year, while freedom from re-intervention was 95% (95%CI: 75.5–95) at 1 year, and 77% (95%CI: 50–92) at 5 years. Conclusions In our experience, DTA is a frequent complication from the very beginning of the clinical onset of TBAAD. In this high-risk cohort, TEVAR showed satisfactory results, better than those predicted by the risk score for open repair, with favourable stability of the aortic diameter and no aortic related adverse events during follow-up.
- Published
- 2017
38. Geometric Pattern of Proximal Landing Zones for Thoracic Endovascular Aortic Repair in the Bovine Arch Variant
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Massimiliano M. Marrocco-Trischitta, Moad Alaidroos, Rodrigo M. Romarowski, Francesco Secchi, Paolo Righini, and Giovanni Nano
- Subjects
Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2019
39. The Value of the Modified Arch Landing Areas Nomenclature (MALAN) as a Predictor of Outcome After TEVAR
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Massimiliano M. Marrocco-Trischitta, Santi Trimarchi, Joost A. van Herwaarden, Gabriele Piffaretti, Stefano Bonardelli, Mauro Gargiulo, and Hector W.L. de Beaufort
- Subjects
medicine.medical_specialty ,business.industry ,General surgery ,Medicine ,Surgery ,Arch ,Cardiology and Cardiovascular Medicine ,business ,Value (mathematics) ,Nomenclature ,Outcome (game theory) - Published
- 2019
40. Tortuosity of the Descending Thoracic Aorta in Patients with Aneurysm and Type B Dissection: A Quantitative Analysis
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Jean Bismuth, Massimiliano M. Marrocco-Trischitta, Frans L. Moll, Viony M. Belvroy, Joost A. van Herwaarden, Hector W.L. de Beaufort, and Santi Trimarchi
- Subjects
medicine.medical_specialty ,business.industry ,medicine.disease ,Type b dissection ,Tortuosity ,Aneurysm ,medicine.artery ,medicine ,Thoracic aorta ,Surgery ,In patient ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Quantitative analysis (chemistry) - Published
- 2019
41. A Systematic Review and Meta-analysis of the Bovine Aortic Arch Variant as a Determinant of Thoracic Aortic Disease
- Author
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Francesco Secchi, Paolo Righini, Massimiliano M. Marrocco-Trischitta, Rodrigo M. Romarowski, Giovanni Nano, and Moad Alaidroos
- Subjects
Aortic arch ,medicine.medical_specialty ,business.industry ,medicine.artery ,Internal medicine ,Meta-analysis ,medicine ,Cardiology ,Surgery ,Thoracic aortic disease ,Cardiology and Cardiovascular Medicine ,business ,A determinant - Published
- 2019
42. TAA 16. Biomechanical Pattern of Proximal Landing Zones for Thoracic Endovascular Aortic Repair in the Bovine Arch Variant
- Author
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Rodrigo M. Romarowski, Giovanni Nano, Moad Alaidroos, Mattia Glauber, Francesco Secchi, Paolo Righini, Francesco Sturla, and Massimiliano M. Marrocco-Trischitta
- Subjects
business.industry ,Bovine arch ,Medicine ,Surgery ,Anatomy ,Cardiology and Cardiovascular Medicine ,business ,Aortic repair - Published
- 2019
43. Correlation of Clinical and Ultrasound Variables to Vulnerability of Carotid Plaques in Patients Submitted to Carotid Endarterectomy
- Author
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Giovanni Malacrida, Giovanni Nano, Alfredo Modafferi, Federico Ambrogi, Massimiliano M. Marrocco-Trischitta, Paolo Righini, Valentina Milani, and Daniela Mazzaccaro
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Carotid endarterectomy ,030204 cardiovascular system & hematology ,medicine.disease_cause ,Risk Assessment ,030218 nuclear medicine & medical imaging ,Brain Ischemia ,Decision Support Techniques ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Risk Factors ,medicine ,Humans ,Carotid Stenosis ,Ultrasonography, Interventional ,Endarterectomy ,Aged ,Retrospective Studies ,Univariate analysis ,Endarterectomy, Carotid ,Framingham Risk Score ,business.industry ,Reproducibility of Results ,General Medicine ,Odds ratio ,medicine.disease ,Vulnerable plaque ,Plaque, Atherosclerotic ,Stroke ,Nomograms ,Carotid Arteries ,Treatment Outcome ,Predictive value of tests ,Surgery ,Female ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Magnetic Resonance Angiography - Abstract
Background The aim of this study is to investigate the correlation of clinical and ultrasound parameters with characters of vulnerable atherosclerotic carotid plaque, as evaluated at preoperative magnetic resonance angiography (MRA), in patients submitted to carotid endarterectomy (CEA), in order to develop a clinical risk score for plaque vulnerability. Methods Preoperative data of patients submitted to CEA for significant carotid stenosis from January 1, 2012 to December 31, 2016 were retrospectively collected. The available case series was randomly divided into 2 groups, including a training (60%) and a validation series (40%). Data of plaque vulnerability were assessed at preoperative MRA scans. Univariate analysis was used on the training series to correlate the preoperative covariates available to the features of plaque vulnerability. Therefore, a backward selection procedure was performed again on the training series and on the validation series to assess if the same variables were associated to data of plaque vulnerability, in order to obtain a prediction model for the risk of plaque vulnerability. Odds ratios (ORs) with 95% confidence intervals were reported. P values Results The training case series consisted of 352 patients, while the validation case series of 248 patients. After univariate analysis and logistic regression, on the training and the validation series respectively, 6 variables were significantly associated to features of vulnerable plaque at preoperative MRA. These included male sex (OR 2.05), diabetes mellitus (OR 3.06), coronary artery disease (OR 1.95), neutrophil/lymphocyte ratio (OR 17.99), platelet counts (OR 1.03), and gray-scale median value (OR 0.84). A nomogram was then obtained from the final logistic model, in order to predict the probability of the presence of vulnerable carotid plaque, using a weighted points system. This risk score was then applied to the validation series. The validation data were found to have a C-index of 0.934. Conclusions Sex, diabetes mellitus, coronary artery disease, neutrophil/lymphocyte ratio, platelet counts, and gray-scale median value were significantly associated to the features of vulnerable plaque at preoperative MRA in patients undergoing CEA. In particular, when combined together in a “risk score,” these variables provided an accurate probability of the presence of a vulnerable plaque at MRA scans.
- Published
- 2019
44. Impact of the Bird-Beak Configuration on Postoperative Outcome After Thoracic Endovascular Aortic Repair: A Meta-analysis
- Author
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Moad Alaidroos, Valentina Milani, Massimiliano M. Marrocco-Trischitta, Giovanni Nano, Federico Ambrogi, Benedetta Spampinato, Girolomina Mazzeo, and Daniela Mazzaccaro
- Subjects
Aortic arch ,medicine.medical_specialty ,Endoleak ,Aortic Diseases ,Aorta, Thoracic ,Prosthesis Design ,Risk Assessment ,Blood Vessel Prosthesis Implantation ,Foreign-Body Migration ,Risk Factors ,medicine.artery ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Cumulative incidence ,business.industry ,Endovascular Procedures ,Absolute risk reduction ,Hemodynamics ,Publication bias ,medicine.disease ,Curvatures of the stomach ,Thrombosis ,Confidence interval ,Surgery ,Blood Vessel Prosthesis ,Treatment Outcome ,Meta-analysis ,Stents ,Cardiology and Cardiovascular Medicine ,business - Abstract
Purpose: To investigate the association between the bird-beak configuration (BBC), a wedge-shaped gap between the undersurface of a thoracic endograft and the lesser curvature of the arch after thoracic endovascular aortic repair (TEVAR), and postoperative outcome after TEVAR. Methods: The study was performed according to the PRISMA guidelines. The PubMed, EMBASE, and Cochrane databases were searched to identify all case series reporting BBC after TEVAR between 2006 and April 2018. Data analysis was performed considering the difference in the risk of complications for presence vs absence of BBC. After screening 1633 articles, 21 studies were identified that matched the selection criteria; 12 of these reported detailed information to investigate the postoperative outcome using proportion meta-analysis with a random effects model. The pooled risk difference is reported with the 95% confidence interval (CI). Heterogeneity of the included studies was assessed with the I2 statistic (low 25%, medium 50%, high 75%). Results: Complications occurred within a range of 0 to 72 months in 14.7% (95% CI 7.4% to 27.3%) of patients with BBC and in 6.3% (95% CI 2.5% to 15.4%) of patients without BBC. A cumulative incidence could not be assessed. The summary risk difference was 11.1% (95% CI −0.1% to 22.3%, p=0.052). There was significant heterogeneity ( I2=85.6%). The Egger test did not show evidence of publication bias (p=0.975). When specifically considering type Ia endoleak and endograft migration, the risk difference between BBC and non-BBC patients was 8.2% (95% CI 0.3% to 16.1%, p=0.042; I2=69.0%). The specific risk difference for endograft collapse/infolding and thrombosis was 3.7% (95% CI −3.5% to 11.1%, p=0.308; I2=10.2%). Conclusion: At present the literature does not provide statistical evidence to establish an overall prognostic value of the BBC. Nevertheless, the BBC appears to be associated with a high risk of type Ia endoleak and endograft migration, which warrants specific and long-term surveillance. Clinically relevant values for BBC grading should be established to perhaps define indications for preemptive treatment based on the presence of BBC only.
- Published
- 2019
45. Clinical implications of biomechanical insights into thoracic endovascular aortic repair
- Author
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Rodrigo M. Romarowski and Massimiliano M. Marrocco-Trischitta
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,Aortic Rupture ,Endovascular Procedures ,Aorta, Thoracic ,General Medicine ,Aortic repair ,Surgery ,Blood Vessel Prosthesis Implantation ,Medicine ,Humans ,Cardiology and Cardiovascular Medicine ,business ,Aortic rupture ,Letters to the Editor - Published
- 2019
46. Factors affecting the occurrence of proximal endoleak after endovascular abdominal aortic repair for abdominal aneurysms
- Author
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Alfredo Modafferi, Gianmarco Zuccon, Daniela Mazzaccaro, Girolomina Mazzeo, Giovanni Malacrida, Giovanni Nano, Paolo Righini, and Massimiliano M. Marrocco-Trischitta
- Subjects
Medicine (General) ,medicine.medical_specialty ,Endoleak ,Special Issue: The Cutting Edge of Aortopathy ,proximal neck area ,030204 cardiovascular system & hematology ,Aortic repair ,Biochemistry ,Blood Vessel Prosthesis Implantation ,03 medical and health sciences ,R5-920 ,abdominal aortic aneurysm ,0302 clinical medicine ,Risk Factors ,medicine ,Humans ,In patient ,030212 general & internal medicine ,Retrospective Studies ,oversizing ,business.industry ,Endovascular Procedures ,Biochemistry (medical) ,Proximal endoleak ,endograft ,Retrospective cohort study ,Cell Biology ,General Medicine ,medicine.disease ,Abdominal aortic aneurysm ,Blood Vessel Prosthesis ,endovascular abdominal aortic repair ,Surgery ,Treatment Outcome ,Radiological weapon ,Abdominal aneurysm ,business ,Aortic Aneurysm, Abdominal - Abstract
Objective This retrospective study was performed to assess the clinical and radiological variables associated with proximal type IA endoleak (EL) in patients treated with elective endovascular repair for abdominal aortic aneurysms. Methods The chi-square test, t-test, and logistic regression analysis were performed as appropriate. A P value of Results The data of 79 patients were analyzed. No mortality occurred. During follow-up (median, 28.5 months; interquartile range, 12.8–43.0 months), 10 patients developed type IA EL. In the logistic regression analysis, undersizing of the endograft diameter by 20% significantly affected the occurrence of type IA EL. Conclusion When sizing endografts, a discrepancy was noted between the measurements of the diameter and area of the proximal neck. The area might represent a more accurate measurement than the axial diameter to optimize the proximal sealing and lower the risk of developing type IA EL.
- Published
- 2020
47. Activities at Thoracic Aortic Research Center, IRCCS Policlinico San Donato
- Author
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Carlo De Vincentiis, Santi Trimarchi, Alessandro Frigiola, Vincenzo Rampoldi, Marta Cova, Arnoud V. Kamman, Sara Segreti, Michele Conti, Ferdinando Auricchio, Viviana Grassi, Lorenzo Menicanti, Chiara Lomazzi, Massimiliano M. Marrocco-Trischitta, and Simone Morganti
- Subjects
Aortic arch ,Aortic dissection ,3d printed ,Aorta ,medicine.medical_specialty ,business.industry ,General surgery ,education ,030204 cardiovascular system & hematology ,Aortic arch surgery ,medicine.disease ,Aortic repair ,Aortic disease ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,medicine.artery ,cardiovascular system ,Medicine ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business ,Research center - Abstract
The Thoracic Aortic Research Center (TARC) of the IRCCS Policlinico San Donato (PSD) aims to promote research on thoracic aortic diseases, to disclose the scientific knowledge and clinical experience and to develop new scientific paths within the Hospital and the aortic community, in collaboration with other national and international centres. Thoracic Aortic Research Center collaborates with many centres in both Europe (e.g. University of Utrecht, the Netherlands) and the USA (e.g. University of Michigan). This has led to multiple highly regarded publications in respected cardiovascular journals and has led to several PhD programmes resulting in doctorate degrees. Within Italy, in association with the Bioengineering School of the University of Pavia, TARC has founded the “BETA-lab” ( B iomechanics for E ndovascular T reatment of the A orta laboratory), where MDs, Bioengineers, and PhD fellows conduct experimental studies using in vitro/ex vivo models of the physiologic aorta and aortic diseases. Furthermore, a database (iCardiocloud) where the medical imaging of cardiovascular patients from the PSD is structured, for in silico analysis utilizing computational fluid dynamics, and in vitro studies using also 3D printed aortic models. With the role of principal investigator or co-investigator, TARC at PSD has been participating in other several projects, including the International Registry of Acute Aortic Dissection, the International Aortic Arch Surgery Study Group, the European Registry of Endovascular Aortic Repair Complications, the ADSORB and ASSIST trials, and the GREAT registry. International collaborations have included also studies on predictors of aortic growth after dissection with the Yale University and University of Virginia, and on aortic biomarkers with the University of Tokyo.
- Published
- 2016
48. Non-Overt Coagulopathy in Non-ICU Patients with Mild to Moderate COVID-19 Pneumonia
- Author
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Alfredo Modafferi, Daniela Mazzaccaro, Rosa Scaramuzzo, Francesca Giacomazzi, Paolo Righini, Giovanni Malacrida, Matteo Giannetta, Giovanni Nano, Massimiliano M. Marrocco-Trischitta, and Alberto Varriale
- Subjects
medicine.medical_specialty ,lcsh:Medicine ,030204 cardiovascular system & hematology ,Logistic regression ,Article ,DIC ,03 medical and health sciences ,0302 clinical medicine ,respiratory distress ,Internal medicine ,medicine ,Coagulopathy ,Respiratory function ,030212 general & internal medicine ,Stage (cooking) ,disseminated intravascular coagulation ,Disseminated intravascular coagulation ,Respiratory distress ,business.industry ,lcsh:R ,COVID-19 ,General Medicine ,medicine.disease ,Pneumonia ,Breathing ,business - Abstract
Introduction: Aim of the study is to assess the occurrence of early stage coagulopathy and disseminated intravascular coagulation (DIC) in patients with mild to moderate respiratory distress secondary to SARS-CoV-2 infection. Materials and methods: Data of patients hospitalized from 18 March 2020 to 20 April 2020 were retrospectively reviewed. Two scores for the screening of coagulopathy (SIC and non-overt DIC scores) were calculated. The occurrence of thrombotic complication, death, and worsening respiratory function requiring non-invasive ventilation (NIV) or admission to ICU were recorded, and these outcomes were correlated with the results of each score. Chi-square test, receiver-operating characteristic curve, and logistic regression analysis were used as appropriate. p Values <, 0.05 were considered statistically significant. Results: Data of 32 patients were analyzed. Overt-DIC was diagnosed in two patients (6.2%), while 26 (81.2%) met the criteria for non-overt DIC. Non-overt DIC score values &ge, 4 significantly correlated with the need of NIV/ICU (p = 0.02) and with the occurrence of thrombotic complications (p = 0.04). A score &ge, 4 was the optimal cut-off value, performing better than SIC score (p = 0.0018). Values &ge, 4 in patients with thrombotic complications were predictive of death (p = 0.03). Conclusions: Overt DIC occurred in 6.2% of non-ICU patients hospitalized for a mild to moderate COVID-19 respiratory distress, while 81.2% fulfilled the criteria for non-overt DIC. The non-overt DIC score performed better than the SIC score in predicting the need of NIV/ICU and the occurrence of thrombotic complications, as well as in predicting mortality in patients with thrombotic complications, with a score &ge, 4 being detected as the optimal cut-off.
- Published
- 2020
49. AAA 33. Reversed Bell-Bottom Technique for the Endovascular Treatment of Iliac Artery Aneurysms
- Author
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Alfredo Modafferi, Massimiliano M. Marrocco-Trischitta, Daniela Mazzaccaro, Giovanni Nano, Paolo Righini, and Giovanni Malacrida
- Subjects
Iliac artery ,medicine.medical_specialty ,business.industry ,medicine ,Surgery ,Endovascular treatment ,Cardiology and Cardiovascular Medicine ,business - Published
- 2019
50. Regarding 'Baroreceptor Activation Therapy 2 Decades after Vascular Surgery on Both Carotid Arteries in a Patient with Resistant Hypertension: First Case Report in the Literature'
- Author
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Massimiliano M. Marrocco-Trischitta
- Subjects
medicine.medical_specialty ,Baroreceptor ,business.industry ,Carotid arteries ,Resistant hypertension ,Blood Pressure ,Pressoreceptors ,General Medicine ,030204 cardiovascular system & hematology ,Vascular surgery ,Baroreflex ,03 medical and health sciences ,0302 clinical medicine ,Carotid Arteries ,Internal medicine ,Hypertension ,Cardiology ,Medicine ,Humans ,Surgery ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business - Published
- 2018
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