Search Results (23)

Background/Objectives: Blunt thoracic aortic injury (BTAI) is a rare, highly lethal trauma typically occurring at the aortic isthmus. Advanced BTAI is primarily treated with thoracic endovascular aortic repair (TEVAR). Because emergent surgical debranching is rarely feasible, management depends heavily on patient anatomy, especially regarding the left subclavian artery (LSA). Patient-specific computational fluid dynamics (CFD) models offer critical insights into periprocedural planning and outcome prediction. Methods: This study investigates hemodynamic changes in a patient-specific BTAI case following intentional LSA coverage by a stent graft. Three-dimensional patient-specific models were coupled with RCR-Windkessel boundary conditions for both pre- and post-procedural imaging data to simulate blood flow in each scenario. Results: Post-intervention, flow distribution improved significantly; relative perfusion to the brachiocephalic trunk and left common carotid artery increased by 3.51% and 4.02%, respectively, alongside an elevated overall pressure throughout the entire computational domain. However, regions with high oscillatory, low magnitude shear (HOLMES), specifically wall areas with values < 0.3 Pa, expanded post-stenting. This warrants careful monitoring during follow-ups, given the associated risk of thrombus formation. Furthermore, time-averaged swirling strength (TASS) variation along the aorta decreased (standard deviation dropped from 1.8610 to 1.3835), indicating stabilized flow within the stented region, while normalized swirling strength increased distally. Conclusions: This study establishes an effective, non-invasive framework for assessing pre- and post-TEVAR hemodynamics. It demonstrates that LSA coverage induces uniformly elevated pressure and alters wall shear stress and helicity indices, highlighting the need for future research into pharmacological management to optimize long-term outcomes. Full article

Background: Pituitary adenylate cyclase-activating polypeptide (PACAP) functions as an anti-atherogenic neuropeptide. Maxadilan, a PAC1 receptor agonist, offers atheroprotection by acting downstream of vascular inflammation caused by hypercholesterolemia. This study aims to explore how PACAP and Maxadilan influence migration and apoptosis in human coronary artery smooth muscle cells (HCASMCs). Methods: To investigate the role of PACAP deficiency in the pathogenesis of atherosclerosis under standard chow (SC) in vivo, PACAP^−/−-mice were crossed with ApoE^−/−-mice to generate PACAP^−/−/ApoE^−/−-mice. The whole aorta was isolated and stained with OilRedO (ORO). Atherosclerotic lesions and lumen stenosis in the brachiocephalic trunk were quantified using ImageJ 1.54p (Fiji). To further investigate the role of PACAP and Maxadilan in the pathogenesis of atherosclerosis with special respect to HCASMC under a lipid-enriched environment, HCASMCs were treated with oxLDL, with or without PACAP or Maxadilan. Uptake and accumulation of oxLDL were analyzed using Bodipy^TM493/503, and cell viability was assessed with PrestoBlue^®. Cell migration was evaluated using the scratch assay and the MRI wound-healing tool in ImageJ (Fiji). Mitochondrial morphology was examined with MitoTracker Green and the MiNA tool in ImageJ (Fiji). Apoptotic processes were analyzed by Western blot, immunocytofluorescence staining, and ELISA. Results: In vivo, PACAP^−/−/ApoE^−/−-mice showed increased lumen stenosis and decreased plaque burden compared with ApoE^−/−-mice. In vitro, PACAP enhanced the viability of oxLDL-treated HCASMCs, while neither PACAP nor Maxadilan influenced lipid content in HCASMCs, regardless of oxLDL presence. Both oxLDL and PACAP slowed cell migration, but Maxadilan increased migration in oxLDL-treated HCASMCs. The protein level of the proliferation marker Ki67 was reduced in cells treated with oxLDL and Maxadilan. Additionally, BAX, which promotes intrinsic apoptosis, was elevated in HCASMCs stimulated with Maxadilan and oxLDL. Investigations of mitochondrial morphology indicated that oxLDL and PACAP increased the individual and network structures, with a decrease in branches per network. Conclusion: Our data highlight the complex role of the PACAP/PAC1 system in vascular pathology and suggest that selective modulation—such as targeted PAC1 activation or PACAP supplementation—could lead to new strategies for stabilizing atherosclerotic plaques. In the long term, this could improve the balance between plaque formation and vascular function. Full article

Aim: We aimed to provide a structured ex vivo protocol for cardiopulmonary micro-CT that combines gelatin–barium sulfate (gelatin–BaSO₄) contrast medium with agar embedding in neonatal canine cardiopulmonary specimens. Materials and Methods: Heart–lung specimens from 23 puppies that died shortly after birth were collected, stored at −20 °C, and then slowly thawed prior to imaging. Before perfusion, body mass and heart–lung complex mass were recorded. Body mass ranged from 140 to 951 g, and heart–lung complex mass ranged from 1.2 to 51.2 g. The cranial and caudal venae cavae, the brachiocephalic trunk, and the left subclavian artery were ligated. A catheter was introduced into the thoracic aorta. Contrast was prepared by dissolving porcine gelatin in hot water and mixing with a commercial BaSO₄ suspension. The mixture was maintained at a warm temperature to remain free-flowing and was delivered at low pressure until uniform opacification of the coronary and pulmonary arteries was observed. After in situ gelation, the organs were embedded in warm agar and sealed to limit motion and dehydration. Scans were performed on a benchtop system (120 kV, ~83 µA, ~1200 projections, ~2 s exposures; voxel ~40 µm). Reconstruction was performed in XMReconstructor, with post-processing in Falcon and RadiAnt. The reconstructed micro-CT datasets were reviewed anatomically by a medical cardiologist and a veterinary cardiologist, whereas vascular filling was evaluated semi-quantitatively by three observers with expertise in veterinary anatomy and cardiology. Results: In all specimens examined, the main coronary artery course was assessable. Conclusions: The gelatin–BaSO₄ contrast medium combined with agar immobilization provides a simple, lead-free, and affordable approach for structured cardiopulmonary micro-CT in very small post-mortem specimens. In the examined specimens, the workflow provided visually consistent low-pressure vascular opacification without gross evidence of vessel rupture or motion-related acquisition failure under the conditions of this study. Practical mitigations included temperature/viscosity control, avoidance of phosphate buffers, container sealing, and minimization of particle aggregation, bubbles, and dehydration. The protocol may complement conventional autopsy in very small post-mortem specimens in similar ex vivo research settings. Full article

Introduction: Ischemic stroke in young adults is uncommon and is frequently associated with rare etiologies, including autoimmune diseases and vasculitis. Takayasu arteritis (TA) is a chronic inflammatory large-vessel arteriopathy involving the aorta and its major branches and may result in cerebral ischemia due to arterial stenosis or thrombosis. Case Presentation: We report the case of a 26-year-old woman with a history of suspected rheumatoid arthritis and Lyme disease who presented with acute left-sided hemiparesis and dysarthria. At admission, large-vessel vasculitis had not yet been suspected, and the patient was treated according to standard acute stroke protocols. Computed tomography angiography (CTA) revealed occlusion of the right middle cerebral artery bifurcation and the right common carotid artery, with inflammatory changes involving the brachiocephalic trunk and subclavian arteries. Intravenous thrombolysis (iv rtPA) was followed by mechanical thrombectomy (MT), resulting in neurological improvement. Outcome: Further diagnostic work-up confirmed TA, and immunosuppressive therapy with cyclophosphamide and infliximab was initiated. Conclusion: This case underscores the importance of considering inflammatory large-vessel disease in young patients presenting with acute ischemic stroke and illustrates that endovascular reperfusion may be feasible in this clinical setting. Full article

Background: Animal models are essential for translating diagnostic and therapeutic strategies into clinical practice and offer valuable insights into the pathophysiology of diseases such as aortic dissection. This study presents a novel acute in vivo large animal model of Stanford type A aortic dissection, combining open surgical access with endovascular techniques to leverage the advantages of both. The model aims to reproducibly simulate acute dissections in swine, providing a standardized platform for evaluating diagnostics, disease mechanisms, and treatment strategies. Methods: Six pigs underwent a standardized protocol to induce aortic dissection. Arterial pressure was monitored via femoral and carotid catheterization. A conventional sternotomy was performed, followed by tangential cross-clamping of the ascending aorta and a controlled incision proximal to the brachiocephalic trunk. The intima and the media were separated using a guidewire and catheter-based technique to create a false lumen. A re-entry tear was also established to allow for controlled intraluminal access. Animals were monitored for 12 h post-intervention, with serial blood sampling. At the end of the experiment, the animals were euthanized and the aortas harvested for macroscopic and histological analysis. Results: In all 6 animals, the placement of arterial catheters in femoral and carotid arteries, as well as the sternotomy, was established without any complications. The dissection model was successfully created in 5 out of 6 animals by clinical signs such as adventitial hematoma, macroscopic wall separation and/or decreased femoral blood pressure. One animal experienced complete aortic perforation. Five animals completed the full observation period of 12 h. Conclusion: A standardized, reproducible, and robust large animal model of acute Stanford type A aortic dissection using a hybrid approach was developed. This model closely simulates the clinical and pathological features of human aortic dissection, making it a valuable tool for preclinical research in diagnostics, pathophysiology, and treatment development. Full article

Background and Objectives: The branching pattern of the aortic arch (AA) is highly variable, with the typical supra-aortic branching configuration observed in about three out of four cases. Even though some variants carry a heightened risk for certain diseases and intraoperative complications, they are often underrepresented in standard textbooks. One of the earliest meta-analyses on this topic was published by Dr. Herbert Lippert in 1967. This study aims to use modern imaging to identify AA variations, compare the prevalence with Lippert’s findings, and evaluate the relevance of his classification in today’s Central European population. Materials and Methods: Computed tomography angiography (CTA) scans of 400 patients were retrospectively analyzed and categorized according to Lippert’s classification of AA variations. The prevalence of each variation was calculated and compared to the results reported by Lippert. Results: The typical AA branching was observed in 75.5% of cases. Brachiocephalic trunk variations were the second most common, occurring in 19.5% of patients. Variations involving the left vertebral artery branching directly off the AA had a prevalence of 4%. Additionally, two cases (0.5%) exhibited a thyroidea ima artery originating from the AA, and two cases (0.5%) demonstrated an arteria lusoria with a retroesophageal course. Conclusions: Lippert’s classification remains highly relevant in describing supra-aortic branching pattern prevalence within today’s Central European population. Although most variants are of limited clinical relevance, some can become symptomatic or cause complications during medical interventions. Awareness of these variations is therefore essential for optimal patient care. Full article

Background: Chest radiography (CXR) remains the most common first-line imaging for thoracic abnormalities. While aortic knob width can reflect aortic dilation, no standardized, widely recognized thresholds of clinical utility exist. Methods: This pilot retrospective study analyzed 240 emergency department patients (median age 67 years, 61% male) who underwent both PA CXR and chest computed tomography angiography (CTA) within 7 days. Three aortic knob dimensions (horizontal, oblique, vertical) were measured on CXR and compared with CTA measurements at two anatomical levels: proximal to the brachiocephalic trunk (P-BCT) and distal to the left subclavian artery (D-LSA). Results: The horizontal aortic knob width was most closely related to CTA measurements of P-BCT and D-LSA. A regression model incorporating horizontal knob diameter, age, and sex was characterized with an AUC of 0.884 (95% CI 0.825–0.944) for detecting aortic dilation (>40 mm). Using a conservative threshold with the upper 95% prediction bound exceeding 40 mm led to 100% sensitivity and 54% specificity, with a negative predictive value of 1.00. Conclusions: Simple quantitative CXR measurements of aortic knob width (horizontal), combined with age and sex, can provide additional confidence for excluding aortic arch dilation. Given further validation in diverse populations, if the high negative predictive value of this approach will be confirmed, it may represent a valuable screening tool to guide decisions for advanced imaging, especially due to low cost and wide availability. Full article

Paradoxical embolism occurs when a clot originates in the venous system and traverses through a pulmonary or intracardiac shunt into the systemic circulation, with a mortality rate of around 18%. The risk factors for arterial embolism and venous thrombosis are similar, but different disease entities can lead to a hypercoagulable state of the blood, including antithrombin III (AT III) deficiency. We report the case of a 43-year-old man with a massive central pulmonary embolism with a rider embolus and concomitant aortic arch embolism with involvement of the brachiocephalic trunk, bilateral subclavian and axillary arteries, and the right vertebral artery, followed by a secondary ischaemic stroke. The Pulmonary Embolism Response Team (PERT) consulted the patient on several occasions; he was treated initially with an intravenous infusion of unfractionated heparin under activation partial thromboplastin time (APTT) and AT III substitution. After several days of hospitalisation and the conversion of pharmacotherapy to oral anticoagulants, the patient was discharged home in a stable condition with recommendations for further follow-up in appropriate clinics. This case highlights the role of in-depth diagnostics for coagulation disorders in patients after pulmonary embolism, especially without known risk factors. Full article

Aortic arch anomalies represent a range of congenital vascular malformations resulting from disruptions in the typical embryological development of the aortic arch and its branches. These anomalies, which vary widely in their presentation, can lead to significant clinical symptoms depending on their structure and position. We report the case of a 75-year-old male with intermittent hypertension, palpitations, and episodic warmth in the upper body. Computed tomography (CT) angiography revealed an atypical aortic arch anatomy with a unique right subclavian artery anomaly. The aortic arch displayed a typical orientation but included an additional arterial branch arising from the medial wall of the descending aorta. This aberrant branch with a tortuous aspect coursed posteriorly around the esophagus and merged with the subclavian branch of the brachiocephalic trunk, forming a vascular ring. A possible embryological hypothesis requires the persistence of both the distal segment of the right dorsal aorta and the right seventh intersegmental artery, as well as the right fourth aortic arch; however, the imaging aspect of our patient is not that of a classic double aortic arch. This case emphasizes the importance of advanced imaging techniques, such as CT angiography, in identifying and managing rare vascular anomalies that may influence patient care and clinical outcomes. Full article

A possible involvement of immune- and vasoregulatory PACAP signaling at the PAC1 receptor in atherogenesis and plaque-associated vascular inflammation has been suggested. Therefore, we tested the PAC1 receptor agonist Maxadilan and the PAC1 selective antagonist M65 on plaque development and lumen stenosis in the ApoE^−/− atherosclerosis model for possible effects on atherogenesis. Adult male ApoE^−/− mice were fed a cholesterol-enriched diet (CED) or standard chow (SC) treated with Maxadilan, M65 or Sham. Effects of treatment on atherosclerotic plaques, lumen stenosis, apoptosis and pro-inflammatory signatures were analyzed in the brachiocephalic trunk (BT). The percentage of Maxadilan treated mice exhibiting plaques under SC and CED was lower than that of Sham or M65 treatment indicating opposite effects of Maxadilan and M65. Maxadilan application inhibited lumen stenosis in SC and CED mice compared to the Sham mice. In spite of increased cholesterol levels, lumen stenosis of Maxadilan-treated mice was similar under CED and SC. In contrast, M65 under SC or CED did not reveal a significant influence on lumen stenosis. Maxadilan significantly reduced the TNF-α-immunoreactive (TNF-α⁺) area in the plaques under CED, but not under SC. In contrast, the IL-1β⁺ area was reduced after Maxadilan treatment in SC mice but remained unchanged in CED mice compared to Sham mice. Maxadilan reduced caspase-3 immunoreactive (caspase-3⁺) in the tunica media under both, SC and CED without affecting lipid content in plaques. Despite persistent hypercholesterolemia, Maxadilan reduces lumen stenosis, apoptosis and TNF-α driven inflammation. Our data suggest that Maxadilan provides atheroprotection by acting downstream of hypercholesterolemia-induced vascular inflammation. This implicates the potential of PAC1-specific agonist drugs against atherosclerosis even beyond statins and PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitors. Full article

Late ischaemic consequences of type A aortic dissection are rare. We present a 6-year late complication of type A aortic dissection treated by Bentall surgery in a 41-year-old patient. The patient presented with several episodes of lipothymia associated with hypertensive attacks with anisotension, cervicalgia, hemicranial headache, abdominal pain and lower limb slipping initially on exertion and later at rest. On dynamic examination, we diagnosed an intermittent dynamic occlusion of the aortic arch and rare LOX gene variation, which is considered to be associated with aneurysm or dissection of the ascending aorta in young patients. Surgical treatment by replacement of the ascending aorta and the aortic arch with reimplantation of the brachiocephalic trunk (BcTr) allowed the symptoms to resolve. Full article

(1) Background: This study aimed to morphologically analyze acute type A aortic dissection (aTAAD) patients for potential endovascular treatment candidates. The objective was to specify requirements for aTAAD endovascular devices. (2) Methods: A single-center retrospective analysis included aTAAD patients who underwent open surgical repair between November 2005 and December 2020. Preoperative CTA scans were used for morphological analysis, assessing endovascular repair eligibility. Statistical tests were performed. (3) Results: A total of 129 patients with aTAAD were studied, with 119 included. Entry tear (ET) locations were identified, mainly in the aortic root, 20 mm above the sinotubular junction (STJ) and within the ascending aorta (20 mm above STJ to −20 mm before the brachiocephalic trunk). Endovascular treatment was deemed feasible for 36 patients, with suggested solutions for the aortic arch and descending aorta. Significant differences were observed between eligible and noneligible groups for aortic diameter, false lumen diameter, distance between STJ and entry tear, and more. Dissection extension showed no significant difference. (4) Conclusions: Morphological analysis identified potential aTAAD candidates for endovascular treatment, highlighting differences between eligible and noneligible morphologies. This study offers insights for implementing endovascular approaches in aTAAD treatment and emphasizes the need for research and standardized protocols. Full article

(1) Background. The anatomical variations of the vertebral arteries (VAs) have a significant impact both in neurosurgery and forensic pathology. The purpose of this study was to evaluate the variational anatomy of the vertebral artery. We evaluated anatomical aspects regarding the V1 and V2 segments of the VA: origin, course, tortuosity, hypoplasia, and dominance, and established the prevalence of each variation. (2) Methods. We conducted a systematic search in PubMed and Google Scholar databases, up to December 2022. Sixty-two studies, comprising 32,153 vessels, were included in the current meta-analysis. We used a random-effects model with a DerSimonian-Laird estimator. The confidence intervals were set at 95%. The heterogeneity between studies was assessed using I². The funnel plot and Egger’s regression test for plot asymmetry were used for the evaluation of publication bias. Statistical significance was considered at p < 0.05. (3) Results. The most common site for the origin of both VAs was the subclavian artery. The aortic arch origin of the left VA had a prevalence of 4.81%. Other origins of the right VAs were noted: aortic arch (0.1%), right common carotid artery (0.1%), and brachiocephalic trunk (0.5%). Ninety-two percent of the VAs entered the transverse foramen (TF) of the C6 vertebra, followed by C5, C7, C4, and least frequently, C3 (0.1%). Roughly one out of four (25.9%) VAs presented a sort of tortuosity, the transversal one representing the most common variant. Hypoplasia occurred in 7.94% of the vessels. Left VA dominance (36.1%) is more common, compared to right VA dominance (25.3%). (4) Conclusions. The anatomy of the VA is highly irregular, and eventual intraoperative complications may be life-threatening. The prevalence of VA origin from the subclavian artery is 94.1%, 92.0% of the VAs entered the TF at C6, 26.6% were tortuous, and 7.94% were hypoplastic. Full article

Background: Rabbit models involving neck arteries are of growing importance for the development of preclinical aneurysm models. An optimal understanding of the anatomy is primordial to allow the conception of models while minimizing mortality and morbidity. The aim of this study is to give reliable anatomical landmarks to allow a standardized approach to the neck vessels. Methods: We performed a necropsy on nine specimens from ongoing experimental studies. We measured the distance between the origins of the right and left common carotid artery (rCCA/lCCA) and between the rCCA and the manubrium sterni (MS). The structures at risk were described. Results: Female New Zealand White rabbits (NZWR) weighing 3.7 ± 0.3 kg and aged 25 ± 5 weeks were included. The rCCA origin was located 9.6 ± 1.2 mm laterally and 10.1 ± 3.3 mm caudally to the MS. In all specimens, the lCCA originated from the aortic arch, together with the brachiocephalic trunk (BCT), and 6.2 ± 3.1 mm proximally to the rCCA origin. The external and internal jugular veins, trachea and laryngeal nerve were the main structures at risk. Conclusions: The data help to localize both CCAs and their origin to guide surgical approaches with the manubrium sterni as a main landmark. Special attention has to be paid to the trachea, jugular veins and laryngeal nerves. Full article

This study investigated the efficacy of aerobic exercise training (AET) in the prevention of dyslipidemia, insulin resistance (IR), and atherogenesis induced by severe low-sodium (LS) diet. LDL receptor knockout (LDLR KO) mice were fed a low-sodium (LS) (0.15% NaCl) or normal-sodium (NS; 1.27% NaCl) diet, submitted to AET in a treadmill, 5 times/week, 60 min/day, 15 m/min, for 90 days, or kept sedentary. Blood pressure (BP), plasma total cholesterol (TC) and triglyceride (TG) concentrations, lipoprotein profile, and insulin sensitivity were evaluated at the end of the AET protocol. Lipid infiltration, angiotensin II type 1 receptor (AT1), receptor for advanced glycation end products (RAGE), carboxymethyllysine (CML), and 4-hydroxynonenal (4-HNE) contents as well as gene expression were determined in the brachiocephalic trunk. BP and TC and gene expression were similar among groups. Compared to the NS diet, the LS diet increased vascular lipid infiltration, CML, RAGE, 4-HNE, plasma TG, LDL-cholesterol, and VLDL-TG. Conversely, the LS diet reduced vascular AT1 receptor, insulin sensitivity, HDL-cholesterol, and HDL-TG. AET prevented arterial lipid infiltration; increases in CML, RAGE, and 4-HNE contents; and reduced AT1 levels and improved LS-induced peripheral IR. The current study showed that AET counteracted the deleterious effects of chronic LS diet in an atherogenesis-prone model by ameliorating peripheral IR, lipid infiltration, CML, RAGE, 4-HNE, and AT1 receptor in the intima-media of the brachiocephalic trunk. These events occurred independently of the amelioration of plasma-lipid profile, which was negatively affected by the severe dietary-sodium restriction. Full article