Search Results (247)

Background/Objectives: This study aimed to investigate the relationship between carotid artery anatomy and geometry and white matter hyperintensities (WMH) and to determine whether it is a risk factor for the disease. Methods: The geometry and anatomy of both carotid arteries were evaluated with the three-dimensional vessel model obtained from the computed tomography angiography (CTA) data, and the segmentation software calculated the geometrical features of the arteries. In this model, vascular diameter, vascular cross-sectional area, carotid bifurcation and internal carotid artery (ICA) angles, as well as ICA tortuosity index (TI) measurements of the common carotid artery (CCA) and ICA were determined. Results: Compared with the non-WMH group, increased carotid bifurcation and ICA angle and higher ICA TI values were found in the WMH group (p < 0.001). In multivariate regression analysis, increased carotid bifurcation angle, higher ICA TI values, age, hypertension, and stroke history were identified as independent risk factors for the development of WMH (p < 0.05). In addition, age, carotid bifurcation angles and ICA angles were found to be associated with the severity of WMH (p < 0.05). Conclusions: Considering the vascular pathologies involved in the pathogenesis of WMH, identifying these risk factors may help determine individuals who are at an increased risk. Full article

Background/Objectives: Endovascular aneurysm repair (EVAR) is currently the preferred method for treating abdominal aortic aneurysms (AAA) due to lower perioperative morbidity and mortality compared with open aortic repair (OAR). However, anatomical limitations such as narrow or tortuous iliac arteries may preclude EVAR. The low-profile Altura^® stent graft (LPSG) was designed to overcome these limitations. This study aimed to compare the outcomes of Altura^® low-profile endografts with standard-profile stent grafts (SPSGs) in AAA treatment. Methods: This single-center, retrospective, case-matched study included 30 patients treated with Altura^® LPSG and 30 matched controls who underwent SPSG implantation between July 2021 and February 2023. Demographic, anatomical, operative, and postoperative parameters were analyzed. Follow-up was performed at 3, 6, and 12 months using ultrasound and computed tomography angiography (CTA). Results: Patients in the LPSG group more frequently had narrow access vessels (<6 mm, 46.7% vs. 3.3%, p = 0.001). The mean procedure time was shorter in the LPSG group (80 vs. 90 min, p = 0.04), and hospital stay was reduced (3 vs. 4 days, p = 0.03). No 30-day mortality occurred in either group. At 12 months, no aneurysm rupture, graft infection, or aneurysm-related death was observed. The rate of secondary interventions was comparable between groups. Conclusions: The low-profile Altura^® stent graft provides a safe and effective option for AAA patients with narrow access vessels. Its bilateral parallel configuration and lack of gate cannulation simplify EVAR, shorten procedure time, and may be especially beneficial in emergency or anatomically challenging cases. Further prospective studies are warranted to confirm these findings. Full article

Background/Objectives: The possibilities of endovascular and minimally invasive treatment of visceral and renal artery aneurysms require precise procedure planning. Accurate visualization of vascular pathologies is crucial in this regard. Expanding diagnostic imaging with real 3D models is one of these methods. The objective of our study was to evaluate the utility of 3D printing and virtual 3D models in visualizing visceral and renal artery aneurysms. Methods: A group of 30 patients with true aneurysms of the visceral and renal arteries was selected based on computed tomography angiography (CTA). Aneurysm morphology, diameters, arterial diameters, and anatomical vessel variants were analyzed. Imaging data were processed and 3D-printed using Fused Filament Fabrication (FFF) technology. The resulting 3D models were measured, and dimensional deviations were compared to radiological images. Results: The cohort included 51 aneurysms across arteries supplying abdominal organs, with splenic artery aneurysms (49%) and renal artery aneurysms (25.5%) predominating. Half of the patient group had multiple aneurysms, and 36.7% exhibited anatomical arterial variants. Forty-three 3D models of visceral and renal artery aneurysms were generated, accurately depicting isolated vascular pathologies and the course of visceral arteries in regions of interest. Measurement analysis confirmed that the 3D-printed models showed a mean dimensional deviation of 0.24 mm compared to radiological images. Conclusions: 3D-printed and virtual models enhance the analysis of vascular pathologies, significantly improving the assessment of pathological changes and visualization of anatomical details, especially in hilar aneurysms and aneurysm branches. Full article

This retrospective study evaluated the clinical utility of Virtual Reality (VR) in visualizing extracardiac CHD (eCHD) abnormalities involving great vessels, pericardium, or structures outside the heart in nine pediatric patients. Anonymized computed tomography angiography (CTA) DICOM images were processed using Elucis (Version 1.10 elucis next) software to generate interactive 3D models via segmentation. VR models were reviewed for a variety of cases: vascular rings (two with right aortic arch, aberrant left subclavian artery, and diverticulum of Kommerell; two with double aortic arch), pericardial teratomas (n = 2), right superior vena cava draining into the left atrium (n = 1), left pulmonary artery sling (n = 1), and aortopulmonary window (n = 1). VR video images were presented during weekly heart center conferences. A survey conducted among heart center staff assessed the perceived value of VR in clinical practice. A total of 62% found traditional diagnostic modalities very effective, 100% considered VR a valuable diagnostic tool, 65% responded positively to VR image resolution, 50% highlighted its educational benefit, 81% believed VR enhanced diagnostic accuracy and surgical planning, and 100% would recommend its use to colleagues. This study demonstrates the successful integration of VR-based segmentation into clinical workflows, underlining its potential as both an educational resource and a tool to support diagnostic and surgical decision-making. Full article

Haemoptysis arises from diverse respiratory diseases and may involve a broad spectrum of thoracic vessels. Arterial embolisation (AE) is an effective, repeatable, minimally invasive treatment option for life-threatening haemoptysis. This case series included 10 patients (mean age 34 years; six males; five with cystic fibrosis) who underwent 17 AE procedures for life-threatening haemoptysis between January 2018 and September 2025. The study assessed the role of wide-field computed tomography angiography (CTA), extending from the thoracic inlet to L2, in preprocedural planning, bleeding localisation and detection of systemic collaterals. CTA accurately predicted the culprit region in 16 out of 17 procedures. Non-bronchial systemic arteries were identified in 6 out of 10 patients, consistent with previous reports. CTA showed strong concordance with angiography and enabled the detection of uncommon collaterals, including subclavian and phrenic branches. Recurrence of hemoptysis occurred in one patient during follow-up; however, three patients were lost to follow-up. Wide-field CTA enhances the identification of systemic feeders and supports procedural planning, potentially reducing recurrence associated with missed culprit vessels. AE remains a valuable option for haemoptysis control in cystic fibrosis, with outcomes further improved following initiation of CFTR modulators. The small sample size and incomplete follow-up limit generalisability, but findings highlight the importance of CTA in guiding AE and improving clinical outcomes. Full article

Objectives: This review aims to review the application of deep learning (DL) techniques in the imaging analysis of abdominal aortic aneurysm (AAA), with a specific focus on the segmentation of intraluminal thrombus (ILT). Methods: A comprehensive literature review was conducted through searches of PUBMED and Web of Science up to September 2025. Only English-language studies applying DL-based networks for ILT segmentation in patients with AAA on computed tomography angiography were included. After screening 664 articles, 22 met the eligibility criteria and were included. The reported methodological frameworks and segmentation performance metrics were extracted for comparison and analysis. Results: Among the studies included, the reported Dice similarity coefficients ranged from 0.81 to 0.93 for 2D networks and from 0.804 to 0.9868 for 3D networks. Notably, 2D Multiview fusion models outperform other 2D approaches, while 3D U-Net remains a strong baseline. Methods using preoperative images demonstrated great applicability for surgical planning, while postoperative segmentation faced challenges related to imaging artifacts caused by stent. Conclusions: This review provides a comprehensive overview of recent DL-based ILT segmentation methods for AAA patients on CTA, offering perspectives for applications in advanced preoperative planning and postoperative surveillance. Despite the promising results, the lack of standardized datasets limits model development and external validation. Future research should address these limitations by focusing on multicenter standardized datasets and seamless integration into clinical workflows. Full article

Background: Pericarotid adipose tissue (PCAT) characteristics and systemic inflammation may play an important role in carotid endarterectomy (CEA) outcomes. This study explores the association between PCAT Hounsfield Unit (HU) ranges, radiomic features, and systemic inflammatory markers in patients undergoing carotid endarterectomy (CEA). Methods: Twenty patients undergoing CEA were included in this cross-sectional study. PCAT was analyzed using preoperative computed tomography angiography (CTA) images, with regions of interest defined around the carotid arteries. PCAT was categorized into three HU ranges: −190 to −120, −119 to −70, and −69 to −30. Radiomics features were extracted using PyRadiomics. The primary outcome was the correlation of PCAT imaging with preoperative neutrophil-to-lymphocyte ratios (NLRs). The secondary outcome was the association of PCAT imaging with the red cell distribution width (RDW-CV). Linear regression was used to evaluate associations between PCAT characteristics and inflammatory markers. Results: Distinct HU ranges in PCAT imaging showed strong correlations with the preoperative NLR. The −190 to −120 HU range demonstrated a negative association (β = −3.809, p < 0.001), whereas the −119 to −70 HU range showed a positive correlation (β = 3.814, p < 0.001). PCAT uniformity was positively associated with RDW-CV (β = 0.494, p = 0.027). Other radiomics features, such as contrast, showed trends but did not reach statistical significance. A larger outer area of PCAT was inversely associated with the NLR (β = −0.677, p < 0.001). Conclusions: Specific PCAT HU ranges and radiomics features are significantly associated with systemic inflammatory markers in CEA patients. These findings suggest that HU-based segmentation and radiomics analysis of PCAT may offer valuable insights into the relationship between local adipose tissue characteristics and systemic inflammation. Full article

Background and Objectives: Accurate evaluation of vulnerable carotid atherosclerotic plaques remains essential for preventing ischemic stroke. Conventional imaging modalities such as ultrasound and computed tomography angiography (CTA) have limited capacity to identify histopathological features of plaque instability, including fibrous cap rupture, lipid-rich necrotic core, and intraplaque hemorrhage. Artificial intelligence (AI) techniques—particularly deep learning (DL) and radiomics—have recently emerged as valuable adjuncts to standard imaging, achieving AUC values of 0.83–0.99 across modalities in identifying vulnerable plaques. This scoping review summarizes the available evidence on the application of AI in the detection and assessment of vulnerable carotid plaques. Methods: A systematic search of the English-language literature was conducted in MEDLINE, SCOPUS, and CENTRAL from 2000 to 30 June 2025, following the PRISMA-ScR framework. Eligible studies applied AI-based approaches (machine learning, deep learning, or radiomics) to evaluate carotid plaque vulnerability using ultrasound, CTA, or MRI. Extracted outcomes included diagnostic performance, correlation with histopathology or neurological events, and predictive modeling for stroke risk. Results: Of 201 records screened, 12 studies met inclusion criteria (ultrasound = 6; CTA = 4; high-resolution MRI = 2; publication years 2021–2025). All reported receiver operating characteristic area-under-the-curve (ROC-AUC) values for endpoints related to plaque vulnerability (symptomatic versus asymptomatic status, presence of intraplaque hemorrhage or lipid-rich necrotic core, fibrous-cap surrogates, and, less frequently, short-term cerebrovascular events). For ultrasound, contrast-enhanced videomics achieved an AUC of 0.87 (10 centers; n = 205), B-mode texture/radiomics reached 0.87 (n = 150), and segmentation-assisted models 0.827 (n = 202); other ultrasound models reported AUCs of 0.88–0.91. For CTA, a symptomatic-plaque machine-learning model yielded AUC 0.89 ( n = 106); a perivascular-adipose-tissue (PVAT) radiomics nomogram achieved AUC 0.836 on external validation; a histology-referenced pilot attained AUC 0.987; and one mild-stenosis TIA model reported ROC performance. For high-resolution MRI (HR-MRI), radiomics-based models showed AUC 0.835–0.864 in single-modality cohorts and up to 0.984 with multi-contrast inputs. Across modalities, AUC ranges were: ultrasound 0.827–0.91, CTA 0.836–0.987 (external 0.836), and HR-MRI 0.835–0.984. Only two out of twelve studies performed external validation; calibration and decision-curve analyses were rarely provided, and most cohorts were single-center, limiting generalizability. Conclusions: AI demonstrates strong potential as a complementary tool for evaluating carotid plaque vulnerability, with high diagnostic performance across imaging modalities. Reported AUCs ranged from 0.83 to 0.99 based primarily on internal or hold-out validation, representing the upper bound of theoretical rather than real-world performance. Nonetheless, large prospective multicenter studies with standardized protocols, histopathological correlation, and external validation are required before clinical integration into stroke prevention pathways. 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: Extracranial vertebral artery aneurysms (EVAAs) are exceptionally rare vascular lesions and an uncommon cause of posterior circulation stroke. Their diagnosis is often delayed due to nonspecific symptoms, yet prompt recognition is essential to guide management. Objective: This study aimed to report a rare case of an extracranial vertebral artery dissecting aneurysm presenting as a posterior circulation stroke in a young adult, successfully managed with flow-diverter stenting. Clinical Case: A 33-year-old woman presented with sudden-onset dysarthria, vertigo, nausea, and vomiting. Brain magnetic resonance imaging revealed infarcts in the left occipital lobe, cerebellar peduncle, and both cerebellar hemispheres. Computed tomography angiography (CTA) demonstrated a fusiform aneurysm in the V2 segment of the left vertebral artery, and digital subtraction angiography (DSA) confirmed a dissecting aneurysm. The patient was successfully treated with a flow-diverting stent and remained stable at 6 months’ follow-up with mRS 1. Results: EVAA are uncommon but can manifest as posterior circulation ischemic events in young patients. Endovascular treatment with flow-diverting stents has been reported as a feasible option in selected cases, although evidence remains limited to case reports and small series. Conclusions: This case underscores the importance of considering rare yet potentially treatable etiologies of vertebrobasilar stroke in young patients and highlights the value of a multidisciplinary approach to management. Full article

Echocardiography remains a vital part of the initial assessment and monitoring of oncological patients. It allows for proper treatment selection but can also reveal life-threatening complications, including impaired left ventricular function or thromboembolism. It can rarely detect intracardiac masses that require further investigation. In the presented case, a 51-year-old female patient with left-sided breast cancer, who had undergone neoadjuvant chemotherapy, was hospitalised due to a right atrial mass identified via routine transthoracic echocardiography (TTE). Initial anticoagulation therapy showed no clinical improvement. Follow-up TTE revealed a 12 × 19 mm hyperechogenic, mobile mass in the right atrium (RA). Computed tomography angiography (CTA) ruled out pulmonary embolism and revealed that the mass was located close to the tip of the vascular access port. Transoesophageal echocardiography showed that the lesion was not connected to the vascular port. Based on location and mobility, the lesion was most consistent with a cardiac myxoma. After the Heart Team made a decision, endovascular intervention using a vacuum-assisted device was performed without complications. Histopathological examination excluded thrombosis and myxoma, revealing a fibro-inflammatory lesion. A multimodality approach is necessary to assess RA masses. However, even an extensive evaluation could be misleading, so treatment options should always be subject to the Heart Team’s decision. Full article

Background/Objectives: Despite their low incidence, popliteal artery aneurysms (PAAs) are the most common aneurysms of the peripheral arteries and carry a high risk of limb loss. The optimal treatment, either with open (OR) or endovascular repair (ER), remains debated due to the lack of high-level evidence. Methods: In accordance with STROBE guidelines, we conducted a retrospective observational study with a prospective follow-up. All patients presenting with a PAA who underwent elective OR in the Vascular and Endovascular Surgery Unit of Agostino Gemelli Hospital (Rome, Italy) over the last four years were enrollved. Urgent and endovascular cases were excluded. Clinical examination, Doppler ultrasound (DUS), and contrast-enhanced computed tomography angiography (CTA) were performed preoperatively. Clinical and DUS follow-up was performed at 1, 3, 6, and 12 months postoperatively and annually thereafter. Endpoints were the primary, primary assisted, and secondary patency calculated using a Kaplan–Maier estimate based on the “first event” (arterial stenosis, occlusion, or reintervention) after the procedure. Amputation rate and overall mortality were also assessed. The results were compared with the success and complication rates reported in contemporary endovascular series. Results: Overall, 62 open interventions for popliteal artery aneurysms were performed during the study period; 49 patients (100% male, 70.3 SD ± 8.8 years) were included for a total of 52 PAAs treated electively (median diameter 30.5 mm, range 20–75; 92.3% fusiform). Aneurysm involved P1 segment in 38.5% of cases (20), P2 in 48.1% of cases (25), and P3 in 13.5% of cases (7). Two runoff vessels were present in most patients (37, 71.2%). Surgery consisted of the aneurysm’s exclusion through ligation and autologous vein or prosthetic bypass (25, 48.1%) or aneurysmectomy and interposition graft or end-to-end anastomosis (27, 51.9%). At a mean follow-up of 18 months (SD ± 17.7), the primary, the primary assisted, and the secondary patency were 94.3%, 100%, and 100% respectively. No minor nor major amputations and no deaths were reported. Conclusions: In the endovascular era, our results highlight that regardless the specific characteristics—including age, comorbidities, and aneurysm anatomy—OR provides excellent early and mid-term outcomes with high patency and low complication rate compared with contemporary endovascular series reported in the literature. Full article

The aim was to assess the impact of glucagon-like peptide-1 receptor agonists (GLP-1 RA) treatment on the progression of ascending aorta dilatation in patients with type 2 diabetes mellitus (T2DM). A total of 127 T2DM patients with subclinical ascending aortic dilatation (35–45 mm) were prospectively enrolled. Fifty-seven initiated GLP-1 RA therapy (liraglutide, semaglutide, or dulaglutide), while 70 continued on standard care. Ascending aortic diameter was measured by computed tomography angiography (CTA) at baseline and 24 months, alongside circulating markers of vascular remodeling: matrix metalloproteinase-9 (MMP-9), tissue inhibitor of metalloproteinases-1 (TIMP-1), C-reactive protein (CRP), and osteoprotegerin (OPG). Progression of aortic dilatation was significantly lower in the GLP-1 RA group compared with controls (+0.36 ± 0.20 mm vs. +1.05 ± 0.28 mm; p < 0.001). Therapy correlated with decreased MMP-9 and CRP (p < 0.01) and increased TIMP-1 and OPG (p < 0.05). The use of GLP-1 RA was an independent predictor of low progression, even in multivariate models after adjusting for demographic, metabolic, and biomarker data. GLP-1 RA therapy was associated with reduced progression of ascending aortic dilatation in T2DM, supporting a potential vasoprotective role beyond glucose lowering. Full article

Chronic type B aortic dissection (cTBAD) is a challenging condition frequently complicated by persistent false lumen (FL) perfusion, leading to aneurysmal degeneration. Despite significant advances in thoracic endovascular aortic repair (TEVAR), long-term management remains challenging because of continuous FL backflow from distal re-entry tears and progressive aortic dilatation. We present the first documented case of FL exclusion using a custom-made false lumen occlusion device (FLOD). A 77-year-old male who had undergone TEVAR in 2017 underwent computed tomography angiography (CTA) in 2025, with the results revealing aneurysmal degeneration of the descending thoracic aorta (maximum diameter 58.5 mm) and two distal re-entry tears with substantial FL perfusion. Following multidisciplinary evaluation, the patient underwent endovascular reintervention with proximal stent graft extension and the deployment of a custom FLOD into the FL via femoral access. Completion angiography confirmed proper FL exclusion with preservation of visceral artery patency. Transesophageal echocardiography demonstrated rapid FL thrombosis. The patient was discharged on postoperative day 5 in good condition without complications. This case highlights that combining endograft extension with a dedicated FLOD is a safe and effective strategy for selected patients with complex cTBAD anatomy. Full article

Background: Sarcopenia is linked with high rates of adverse surgical outcomes, and computed tomography angiography (CTA)-based psoas measurements are used as imaging sarcopenia surrogates. Their prognostic value in patients with chronic limb-threatening ischemia (CLTI) undergoing revascularization remains uncertain. Objectives: To evaluate whether CTA-derived psoas muscle indices predict complications and mortality after lower-limb revascularization for CLTI. Methods: We performed a retrospective cohort study of consecutive adults who underwent open, hybrid, or endovascular revascularization for CLTI at a single tertiary center (March 2018–December 2021). Psoas muscle area (PMA) and density (PMD) were measured preoperatively on CTA at the mid-L3 vertebral level. Psoas muscle index (PMI) was calculated as PMA/height². Patients were stratified by tertiles for each index (lowest tertile = “sarcopenic” vs. upper two tertiles). Outcomes included early in-hospital complications, late complications, overall complications, late mortality, and overall mortality. Group comparisons used χ²/Fisher tests with false discovery rate (FDR) adjustment; multivariable logistic regression with AIC-guided selection assessed independent predictors. Results: A total of 234 patients were included (median age 68 years; 65.4% men). Early complications occurred in 15.8%; late complications in 70.3%; overall mortality during follow-up was 26.6% (38/143 within follow-up data). In tertile analyses, none of the psoas-derived measures were significantly associated with early complications, late complications, overall complications, or mortality after FDR correction. Lower PMD showed consistent but non-significant trends toward higher late complications (84% vs. 64%), overall complications (87% vs. 72%), overall mortality (38% vs. 21%), and late mortality (37% vs. 20%) (all p < 0.05 unadjusted; all p_adj ≥ 0.139). In multivariable models, PMA, PMD, and PMI were not independent predictors of any outcome. Conclusions: In this retrospective cohort study, preoperative CTA-derived psoas indices were not independent predictors of early, late, or overall complications, nor of in-hospital or follow-up mortality after revascularization for chronic limb-threatening ischemia. Although lower psoas muscle density showed consistent trends toward higher risk, these associations did not reach statistical significance after adjustment. Taken together, our findings suggest that psoas-based measures have limited prognostic value in this setting and should be interpreted cautiously, while their potential role warrants confirmation in larger, prospective studies. Full article