Arteries – ABC CARDIOL

ABCIC

Case Report

Left Internal Thoracic Artery Fistula to the Bronchial Artery: a Rare Cause of Coronary Flow Theft

Marcela Gomes de Souza et al. Alice Mirane Malta Carrijo Vinicius Ferreira Aratani Flávia Bittar Britto Arantes

Introduction

The left internal thoracic artery (LITA) fistula to the pulmonary artery (PA) and/or its branches is a rare condition that was first described in 1947 by Burchell and Clagett and can be acquired or congenital. Its etiologies include, trauma, infection, neoplasms, and mainly myocardial revascularization surgery (MRS).^, The surgical manipulation of the intrathoracic vessels during MRS may predispose a patient to postoperative LITA fistulization to the PA, causing coronary flow leakage and myocardial ischemia. LITA should be considered an etiological diagnosis in cases of persistent angina after MRS.^, Its diagnosis requires coronary cineangiography,^– and its treatment options include conservative drug therapy, surgical ligation, or endovascular intervention.

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ABCIC

Case Report

Anomalous Origin of the Right Coronary from the Left Coronary Sinus: How to approach?

Danielle Campos de Almeida et al. Alice Mirane Malta Carrijo Marcela Gomes de Souza Fernando de Melo Martinelli … Fernando Roberto de Fazzio João Lucas O’Connell

Introduction

Coronary artery anomalies (CAAs) are characterized by a changed vessel origin, path, or structure. It is a rare condition, present in approximately 1% of the general population. These anomalies include the anomalous aortic origin of a coronary artery (AAOCA), which can travel retroaortic, subpulmonic, prepulmonic, and inter-arterial courses.

In general, these abnormalities remain asymptomatic until adulthood, being incidental findings on complementary tests or necropsy. However, they can also cause angina, syncope, ischemia, arrhythmias, or sudden death.^, Sudden death can be the first presentation of this pathology in young athletes, representing the second leading cause of death in this group.

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Original Article

Macroscopic Evaluation of Atherosclerosis in the Arteries: An Autopsy Assessment Tool

Mariana Silva Oliveira et al. Bianca Gonçalves Silva Torquato Maria Helena Soares Maria Luiza Gonçalves dos Reis Monteiro … Guilherme Ribeiro Juliano Laura Sanches Aguiar Vicente de Paula Antunes Teixeira Mara Lúcia da Fonseca Ferraz

Abstract

Background

Atherosclerosis, in some cases, is an asymptomatic condition, and it is important to know the degree of arterial impairment caused by plaques and its association with risk factors. Autopsy examination provides understanding of basic disease processes and assessment to data about macroscopic characteristic of atherosclerotic involvement.

Objective

To macroscopically assess and standardize atherosclerotic involvement of aorta, carotid and iliac arteries and compare with age, gender and causes of death.

Methods

We collected 53 aortic arteries, 53 right carotid arteries, 53 left carotid arteries, 53 right iliac arteries and 53 left iliac arteries. For this assessment, the extension of fatty streaks, atheromatous plaques, fibrosis and calcification were considered, being the reference to score the degree of atherosclerotic involvement. Many degrees of atherosclerosis and accurate values were observed for mild, moderate and severe classification. For statistical analysis, data were analyzed using the software GraphPad Prism® 7.0. Differences were considered statistically significant if p-value was less than 5% (p <0.05).

Results

Carotid arteries had greater atherosclerotic involvement compared to the other arteries (K = 15.73, p = 0.0004). Atherosclerosis was progressive and significant with increasing age (carotid arteries: t = 6.321; p <0.0001; aorta: U = 83.5; p <0.0001; iliac: U = 306; p <0.0001) and as cause of cardiovascular death (carotids: t = 5.047; p <0.0001; aorta: U = 98.5; p = 0.0068; iliac: U = 467.5; p = 0.0012).

Conclusion

Macroscopic assessment of atherosclerosis is an innovative and low-cost way of direct visualization of atherosclerotic plaques, enabling an association with risk factors such as increasing age and cardiovascular diseases, providing important data for clinical practice.

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Original Article

Determinants of Functional and Structural Properties of Large Arteries in Healthy Individuals

Elaine Cristina Tolezani et al. Valéria Costa-Hong Gustavo Correia Alfredo José Mansur … Luciano Ferreira Drager Luiz Aparecido Bortolotto

Background:

Changes in the properties of large arteries correlate with higher cardiovascular risk. Recent guidelines have included the assessment of those properties to detect subclinical disease. Establishing reference values for the assessment methods as well as determinants of the arterial parameters and their correlations in healthy individuals is important to stratify patients.

Objective:

To assess, in healthy adults, the distribution of the values of pulse wave velocity, diameter, intima-media thickness and relative distensibility of the carotid artery, in addition to assessing the demographic and clinical determinants of those parameters and their correlations.

Methods:

This study evaluated 210 individuals (54% women; mean age, 44 ± 13 years) with no evidence of cardiovascular disease. The carotid-femoral pulse wave velocity was measured with a Complior^® device. The functional and structural properties of the carotid artery were assessed by using radiofrequency ultrasound.

Results:

The means of the following parameters were: pulse wave velocity, 8.7 ± 1.5 m/s; diameter, 6,707.9 ± 861.6 μm; intima-media thickness, 601 ± 131 μm; relative distensibility, 5.3 ± 2.1%. No significant difference related to sex or ethnicity was observed. On multiple linear logistic regression, the factors independently related to the vascular parameters were: pulse wave velocity, to age (p < 0.01) and triglycerides (p = 0.02); intima-media thickness, to age (p < 0.01); diameter, to creatinine (p = 0.03) and age (p = 0.02); relative distensibility, to age (p < 0.01) and systolic and diastolic blood pressures (p = 0.02 and p = 0.01, respectively). Pulse wave velocity showed a positive correlation with intima media thickness (p < 0.01) and with relative distensibility (p < 0.01), while diameter showed a positive correlation with distensibility (p = 0.03).

Conclusion:

In healthy individuals, age was the major factor related to aortic stiffness, while age and diastolic blood pressure related to the carotid functional measure. The carotid artery structure was directly related to aortic stiffness, which was inversely related to the carotid artery functional property.

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Artigo Original

Assessment of stent strut endothelialization in iliac arteries of rabbits

Celso Kiyochi Takimura et al. Ii-sei Watanabe Francisco Rafael Martins Laurindo Paulo Sampaio Gutierrez … Vera Demarchi Aiello Spero Penha Morato Pedro Alves Lemos Neto

BACKGROUND: Fast post-implantation stent endothelialization is desirable for theoretically reducing the possibility of stent thrombosis. OBJECTIVE: To evaluate the extent of sirolimus-eluting stent strut endothelialization (delivered from the luminal and abluminal aspects or abluminal aspect only) in the iliac arteries of rabbits. METHODS: The iliac arteries of 10 rabbits were implanted with four sirolimus-eluting stents in the luminal and abluminal aspects, three sirolimus-eluting stents in the abluminal aspect, six polymer-coated stents, and four uncoated stents. After four weeks, the rabbits were euthanized and scanning electron microscopy was performed to quantify the area of exposed stent strut as well as the percentage of endothelialization. RESULTS: The area (mean ± SD) (mm²) of exposed uncoated stent struts, polymer-coated stents, sirulimus-eluting stent in the abluminal and luminal aspects and sirolimus-eluting stent in the abluminal aspect was 0.12 ± 0.08, 0.09 ± 0.12, 0.60 ± 0.67 and 0.05 ± 0.04, respectively (p = 0.120). The percentage of endothelialization (mean ± SD) (%) of uncoated stents, polymer-coated stents, sirolimus-eluting stents in the luminal and abluminal aspects and sirolimus-eluting stents in the abluminal aspect was 99 ± 01, 99 ± 0. 97 ± 03 and 99 ± 0, respectively (p = 0.133). CONCLUSION: After four weeks of implantation in the iliac arteries of rabbits, both the sirolimus-eluting stents in the luminal plus abluminal aspects and those in the abluminal aspect only showed stent strut endothelialization rates similar to those of the other types of non-drug eluting stents.

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Artigo Original

Factors associated with increased radial augmentation index in hypertensive individuals

Renan Oliveira Vaz-de-Melo et al. Adriana Giubilei Pimenta Luiz Tadeu Giollo Júnior Débora Dada Martinelli … Carolina Neves Cosenso Sacomani Juan Carlos Yugar-Toledo José Paulo Cipullo Marco Antônio Mota Gomes Heitor Moreno Júnior José Fernand Vilela-Martin

BACKGROUND: Arterial stiffness is a variable predictor of morbidity and mortality and a possible marker of vascular injury. Its non-invasive assessment by radial tonometry and analysis of the augmentation index (r-AI) allows identifying patients exposed to higher cardiovascular risk. OBJECTIVE: To analyze the influence of r-AI on clinical-biochemical variables and its influence on the prevalence of target-organ damage in hypertensive patients. METHODS: 140 consecutive hypertensive patients, followed-up in an outpatient clinic, were analyzed in a cross-sectional study. Blood pressure (BP) levels and r-AI were obtained by applanation tonometry of the radial artery (HEM-9000AI, Onrom). The patients were allocated into r-AI tertiles (r-AI < 85%; 85< r-AI 97%). RESULTS: The sample was predominantly composed of women (56.4%), mean age of 61.7 ± 11.7 years and body mass index 29.6 ± 6.1 Kg/m². The highest tertile showed higher proportion of women (p = 0.001), higher systolic BP (p = 0.001) and pulse pressure (p = 0.014), and lower weight (p = 0.044), height (p < 0.001) and heart rate (p < 0.001). Multivariate analysis demonstrated that weight (β = -0.001, p = 0.017), heart rate (β = -0.001, p = 0.007) and central pressure (β = 0.015, p < 0.001) correlated independently with r-AI. In logistic regression analyses, the 3rd r-AI tertile was associated to lower levels of diabetes (DM) (OR = 0.41; 95% CI 0.17-0.97; p = 0.042). CONCLUSION: This study demonstrated that weight, heart rate and central BP were independently related to r-AI.

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