Journal of Vascular Diseases

Background: Pulmonary arterial hypertension (PAH) is a serious disease characterized by increased pressure in the pulmonary arteries, which can lead to heart failure and death. Chlorogenic acid (CGA) is a natural compound present in several foods and medicinal plants and has been described to exert a therapeutic effect in various diseases. However, its potential therapeutic effect on PAH remains undeciphered. In this study, the potential of CGA for the treatment of PAH was investigated using network pharmacology analysis and molecular docking. Methods: Potential CGA targets were obtained from the SwissTargetPrediction and GeneCards databases. Moreover, potential PAH targets were collected from the GeneCards and DisGNET databases. Then, common targets were selected, and a protein-protein network (PPI) was constructed between common CGA and PAH targets using the STRING database. The common hub targets were selected, and GO enrichment analysis was performed via KEGG using the DAVID 6.8 database. Additionally, molecular docking analysis was performed to investigate the interaction between CGA and these potential therapeutic targets. Results: We obtained 168 potential targets for CGA and 5779 potential targets associated with PAH. Among them, 133 were common to both CGA and PAH. The main hub targets identified through PPI network analysis were TP53, HIF1A, CASP3, IL1B, JUN, MMP9, CCL2, VEGFA, SRC, IKBKB, MMP2, CASP8, NOS3, MMP1, and CASP1. KEGG pathway analysis showed that these hub targets are associated with pathways such as lipid and atherosclerosis, fluid shear stress and atherosclerosis, and the IL-17 signaling pathway. In addition, the molecular docking results showed a high binding affinity between CGA and the 15 hub PAH-associated targets, further supporting its therapeutic potential. Conclusions: This study provides preliminary evidence on the underlying molecular mechanism of CGA in the treatment of PAH. The findings suggest that CGA could be a promising option for the development of new PAH drugs. Full article

Background: Superficial venous thrombosis (SVT) is a common clinical condition caused by inflammation and the presence of a thrombus inside a superficial vein. It has traditionally been considered a benign and banal disorder, although it can progress or can be associated with thromboembolic disease of deep territories in up to 20%, asymptomatic or symptomatic pulmonary embolism (PE), especially if it affects the main trunk of the internal saphenous vein. The impact of deep vein thrombosis on the quality of life and its sequelae have long been described in the literature; however, they have not been studied in superficial vein thrombosis. Objectives: We aimed to evaluate the risk factors, management, and complications of SVT and its impact on the quality of life of our patients. Methods: Observational, prospective, single-center study to evaluate the management of SVT. The ultrasound (US) was performed initially on symptomatic patients, during treatment with low-molecular-weight heparin (LMWH), at a follow-up, and at the end of 45 days of treatment. A quality-of-life questionnaire was administered to determine the risk factors, management, and complications of SVT at the moment of diagnosis and at the end of treatment. We included patients referred from the emergency department to a monographic consultation for thromboembolic disease, over 18 years of age with a diagnosis of acute SVT symptomatic, without contraindication to initiate anticoagulation. Results: In total, 63 patients were evaluated between October 2020 and April 2022. The mean age was 65.8 years (SD 13.5), of which 35 were women (55.6%), 39 presented cardiovascular risk factors (61.9%), 25 had a history of previous personal venous thromboembolism (VTE) (39.7%), and 10 had obesity (15.9%), 47 had chronic venous insufficiency or varicose veins (74.9%). During follow-up with ultrasound, 39.7% had partial revascularization, and at discharge, 63.5% had permeabilized the thrombosis against 19% who had residual thrombosis or progression of thrombosis. There was a positive correlation between mobility parameters and improvement in the performance of daily activities (rho = 0.35; p = 0.012) and with improvement in pain/discomfort (rho = 0.37; p = 0.007). An improvement in pain parameters was statistically significantly related to a global assessment health perception (rho = 0.48; p < 0.001). Anxiety and depression parameters were related to a global assessment health perception (rho = 0.462; p = 0.001) and to an overall improvement at 12 months (rho = 0.45; p = 0.001). CONCLUSIONS: Superficial venous thrombosis (SVT) is a highly prevalent disease, which is traditionally considered banal and has good evolution, with heterogeneous management in clinical practice and limited information on patient selection for therapies, current treatment routes, and drug use, as well as outcomes. In recent years, the importance of this entity has become evident due to its frequency in clinical practice, its risk of complications, and the impact it has on the quality of life. This study’s results emphasize the importance of the diagnosis, treatment, and follow-up of superficial venous thrombosis. Full article

Physician detection of heart sound abnormality is complicated by the inherent difficulty of detecting critical abnormalities in the presence of noise. Computer-aided heart auscultation provides a promising alternative for more accurate detection, with recent deep learning approaches exceeding expert accuracy. Although combining phonocardiogram (PCG) data with electrocardiogram (ECG) data provides more information to an abnormal heart sound classifier, the scarce presence of labelled datasets with this combination impedes training. This paper explores fine-tuning deep convolutional neural networks such as ResNet, VGG, and inceptionv3, on images of spectrograms, mel-spectrograms, and scalograms. By fine-tuning deep pre-trained models on image representations of ECG and PCG, we achieve 91.25% accuracy on the training-a dataset of the PhysioNet Computing in Cardiology Challenge 2016, compared to a previous result of 81.48%. Interpretation of the model’s learned features is also provided, with the results indicative of clinical significance. Full article

Vascular dementia (VaD), characterized by cognitive decline attributable to cerebrovascular disease, is the second most common type of dementia after Alzheimer’s disease. This review aims to explore the prevalent risk factors, pharmacological interventions, and non-pharmacotherapeutic strategies associated with the condition. Recognized risk factors include advanced age, hypertension, diabetes mellitus, obesity, and hyperlipidemia with emerging evidence implicating additional lifestyle and genetic factors. Pharmacotherapy for VaD mainly focuses on managing these underlying risk factors, coupled with symptomatic treatments. Therapeutic agents commonly used include antihypertensives, statins, antiplatelet drugs, antidiabetic agents, and specific cognitive enhancers like cholinesterase inhibitors. However, the effectiveness of these treatments remains under continuous study, underscoring the need for comprehensive, individualized treatment plans. Non-pharmacotherapeutic strategies, encompassing lifestyle modifications such as diet and exercise have gained considerable attention. They have shown promise in improving cognitive function and enhancing the quality of life in patients with VaD. The application of a multi-domain intervention approach may provide a more holistic management strategy for VaD. Further research is needed to define the best practices in both pharmacotherapy and non-pharmacotherapy treatments, considering the multifactorial and heterogeneous nature of this condition. Full article

The anatomy of the human shoulder predisposes the neurovascular bundle to compression at different levels of the thoracic outlet during abduction of the arm. There are four possible levels of compression at the thoracic outlet pathway: at the costo-clavicular angle, the inter-scalenic angle, under the pectoralis minor muscle or at the level of the humeral head. The positional thoracic outlet compression (TOC) often remains completely asymptomatic. When symptomatic, compressions are collectively referred to as thoracic outlet syndrome (TOS) and may require surgery if physical therapy fails to improve symptoms. The “thoracic outlet compression with complications or sequelae” (the acronym of which is “TOC-CS”, which can be simplified as “TOX”) will almost invariably lead to surgery to release the compression, and other possible treatment targeting the complications as required. There is a continuum between TOC, TOS and TOX, which are simply different clinical stages of the same mechanical issue, just like the Rutherford grades represent different stages of lower extremity arterial disease. We believe that discriminating between TOC, TOS and TOX clarifies clinical definitions and their respective treatment options. TOC is to be considered as a physiological positional phenomenon, TOS requires medical or surgical treatment and surgery should be considered as a primary option in TOX. Full article

Background: Coronary aneurysms are an infrequent finding in diagnostic angiography, with a reported incidence of 0.35–0.7% in the largest contemporary registries. At least half of them have an atherosclerotic etiology and as such they are often diagnosed in the setting of acute coronary syndrome. The wiring of a thrombosed aneurysm is a difficult task and after successful recanalization, the operator has to decide on the optimal method of aneurysm exclusion. Covered stents are commonly deployed, but their use involves the risk of delivery failure as well as device dislodgement and loss due to their stiffness and size. Moreover, proper stent sizing and apposition is difficult in the case of thrombosed aneurysms. Case presentation: We present a case of coronary aneurysm recanalization and exclusion with a covered stent, with a postdilation-induced stent foreshortening. Due to the subsequent stent migration into the aneurysm sac, its repositioning was attempted. The pitfalls of coronary aneurysm stenting and neurointerventional techniques of prolapsed device realignment are discussed. Conclusions: An adequate landing zone is of the utmost importance in aneurysm exclusion with covered stents. In the case of a short stent anchoring in the normal vessel, another covered or conventional stent should be deployed to mitigate the risk of the device migration. Full article

Background: A new physiological monitoring system that simultaneously measures femoral arterial pressure, femoral venous pressure, and cerebral tissue oxygen saturation during CPR was used to evaluate the quality of cardiopulmonary resuscitation. In this case report, we would like to present four representative cases with this physiological monitoring system during CPR. Cases: We invasively measured femoral arterial pressure and femoral venous pressure if catheters were immediately inserted into the femoral artery and femoral vein for potential candidates who required extracorporeal cardiopulmonary resuscitation but did not receive such interventions. We presented several cases, including two cases in which cardiopulmonary resuscitation resulted in higher femoral arterial pressure compared to femoral venous pressure, an upward trend in cerebral tissue oxygen saturation values was observed, and both instances achieved the return of spontaneous circulation. In contrast, we also presented two patients with significant increases in femoral venous pressure and low cerebral tissue oxygen saturation values. In both cases, the return of spontaneous circulation was not achieved. Conclusions: We presented cases in which the femoral venous pressure exceeded the femoral arterial pressure using a simultaneous physiological monitoring system to monitor arterial pressure, venous pressure, and cerebral tissue oxygen saturation during cardiopulmonary resuscitation. Further case accumulations will be necessary to assess the variations in hemodynamic status during cardiopulmonary resuscitation and the association between each hemodynamic status and outcomes after cardiac arrest. Full article

We present our experience with the implantation of flow diverter stents (FDSs) for the management of internal carotid artery (ICA) dissections in tortuous tonsillar loop segments. A total of 16 patients (10 women, 62.5%; mean age 39 ± 8 years; median baseline NIHSS 13; median ASPECTS 8.5) with acute ischemic stroke due to ICA dissection in a tortuous tonsillar loop segment, with/without large intracranial vessel thrombotic occlusion diagnosed between June 2015–February 2022 were included in this retrospective study under a waiver of informed consent. An FDS device was deployed from the petrous ICA toward the upper cervical ICA, completely covering the tonsillar loop. Stentriever-assisted thrombectomy was performed when indicated. A dual antiplatelet regimen was used during and after the procedure. Thrombocyte inhibition levels were evaluated before, during, and after the intervention. The ICA occlusion/near occlusion was successfully recanalized in all 16 patients with mean postangioplasty residual stenosis of 34 ± 14% (range 0–50%). Stent-assisted thrombectomy was performed in 15/16 patients (93.7%), achieving revascularization (TICI 2b–3) in all. There were no procedural complications and no intraprocedural embolic events; one asymptomatic petechial hemorrhage was detected. At 3-month follow-up, mRS 0–2 was seen in all patients. This report provides pilot data for a subsequent study on the use of flow diverter stents for ischemic cerebrovascular conditions. Our encouraging preliminary results await confirmation from further experience and prospective randomized studies. Full article

Background: Pulmonary sequestration (PS), generally diagnosed using computed tomography pulmonary angiography (CTPA), is a rare congenital developmental malformation of the lung that is characterized by nonfunctional lung tissue, independent of the normal lung tissue. This paper summarizes the imaging features of the supplying arteries and draining vessels in patients with PS with an aim to assist in timely clinical diagnosis and operation guidance. Materials and Methods: A total of 55 patients with PS diagnosed using CTPA from multiple clinical centers were retrospectively analyzed. Data included demographic characteristics, imaging features, disease location, isolation type, and the features of supplying and draining vessels, as shown on CTPA images. Results: Of the 55 patients reviewed, 3 (5.45%) were children, 3 (5.45%) were adolescents, and 49 (89.09%) were adults; the mean age was 44 years. Fifty-four (98.18%) patients had intralobar sequestration and one (1.82%) had extralobar sequestration. PS was noted 3.5 times more frequently in the left lower lobe than in the right lower lobe. For the supplying arteries, 47 (85.45%) were derived from the descending thoracic aorta, 1 (1.82%) from the abdominal aorta, 7 (12.73%) from the celiac axis, and 1 (1.82%) from the bronchial artery. The draining vessels were the pulmonary veins in 49 patients (89.09%), the umbilical vein in 1 (1.82%), the venae intercostal in 1 (1.82%), the pulmonary arteries in 11 (20.00%), and the vessels were not shown on the images in 2 patients (3.64%). Conclusion: Clinical presentations of PS are non-specific and can be easily missed or misdiagnosed. However, CTPA can help to improve the diagnostic accuracy and identify the supplying arteries and draining vessels, which significantly contribute to surgical planning. Full article

Background: Vascular health is increasingly recognized for its roles in the pathogenesis and progression of Alzheimer’s disease (AD). The objective of this study was to investigate effects of exercise training, dose, and cardiorespiratory fitness (CRF) on neurotrophic factors in community-dwelling, older adults with mild-to-moderate AD dementia. Methods: This was a pilot blood ancillary study of the FIT-AD trial. Participants in the parent study were randomized to 6-month aerobic exercise (AEx) or stretching control. For this ancillary study, resting plasma brain-derived neurotrophic factor (BDNF), irisin, fibroblast growth factor-21 (FGF-21), and insulin-like growth factor-1 (IGF-1) biomarkers were assessed at baseline, 3, and 6 months. Estimates of within- and between- group effect sizes were calculated (Cohen’s d). Relationships of biomarker change with dose and CRF change were explored with multivariable linear regression and repeated measures correlations. Results: The sample (n = 26, 18 AEx/8 stretching) averaged 77.6 ± 6.9 years old, with the majority being male (65.4%), and non-Hispanic White (92.3%); between-group effect sizes were generally small except for irisin (d = −0.44)), AEx group relative to stretching group. Associations of dose and changes in CRF with changes in neurotrophic biomarker were weak (r² ≤ 0.025). Conclusions: The effects of exercise on BDNF, irisin, IGF-1, and FGF-21 were heterogeneous in AD. Our findings need validation in future, adequately powered exercise studies in AD. Full article

Synchrotron-radiation-computed tomography (SRCT) allows more accurate calcified plaque and coronary stenosis assessment as a result of its superior spatial resolution; however, typical micro-computed tomography (micro-CT) systems have even higher resolution. The purpose of this study was to compare the performance of high-resolution micro-CT with SRCT in the assessment of calcified plaques and a previously published dataset of coronary stenosis assessment. This experimental study involved micro-CT scanning of three-dimensional printed coronary artery models with calcification in situ used in our previously published SRCT study on coronary stenosis assessment. Measurements of coronary stenosis utilizing both modalities were compared using a paired sample t-test. The degrees of stenosis measured on all but one micro-CT dataset were statistically significantly lower than the corresponding SRCT measurements reported in our previous paper (p < 0.0005–0.05). This indicates that the superior spatial resolution of micro-CT was able to further reduce over-estimation of stenosis caused by extensive calcification of coronary arteries and, hence, false positive results. Our results showed that the high-resolution micro-CT used in this study outperformed the Australian Synchrotron SRCT in both calcified plaque and coronary stenosis assessment. These findings will become clinically important for cardiovascular event prediction and enable reclassification of individuals with low and intermediate risk into appropriate risk categories when the technical challenges of micro-CT in clinical practice such as the small field of view and demanding on image processing power are addressed. Full article

Serum calcium levels are known to influence vascular function. Cells infected with human T-cell leukemia virus 1 (HTLV-1) impact serum calcium levels and also affect the endothelium. Since a damaged endothelium causes functional atherosclerosis, serum calcium levels in HTLV-1 carriers may be positively associated with functional atherosclerosis. This cross-sectional study enrolled 1694 Japanese individuals aged 60 to 89 years. Functional atherosclerosis was defined as a cardio-ankle vascular index (CAVI) ≥ 9.0. Logistic regression analysis was used to evaluate the relationship between HTLV-1 carrier status and both serum calcium level and functional atherosclerosis. Even after adjusting for known confounding factors, the serum calcium level was significantly positively associated with functional atherosclerosis only in asymptomatic HTLV-1 carriers. The fully adjusted odds ratio and 95% confidence interval of functional atherosclerosis in relation to a one-standard-deviation increment of serum calcium level (0.4 mg/dL in both men and women) were 1.54 (1.18, 2.01) for HTLV-1 carriers (n = 322) and 0.99 (0.87, 1.13) for HTLV-1 non-carriers (n = 1372), respectively. The serum calcium level was positively associated with functional atherosclerosis only among older carriers of HTLV-1 infection. This finding can help effectively estimate the risk of functional atherosclerosis in asymptomatic HTLV-1 carriers. Full article

Bisphosphonates remain a first-line treatment for osteoporosis. The most-widely used is zoledronate, which is well tolerated by most patients, but may rarely cause acute inflammatory reactions, which resemble those of large vessel vasculitis (LVV). We report a third case of LVV associated with zoledronic acid infusion, presenting with a 2-week history of fever up to 40 °C, flu-like symptoms, left jaw pain, myalgia, arthralgia, ankle stiffness in the morning, and intermittent claudication, diagnosed by the hybrid imaging modality 18F-FDG PET/CT with isolated lower extremity involvement and successfully treated with glucocorticoids. Full article

Cerebrovascular disease (CVD) is a global health concern, and early detection is crucial for effective intervention. This case report presents a 31-year-old male patient with multiple cardiac risk factors who underwent positron emission tomography/computed tomography (PET/CT) with ¹⁸F-sodium fluoride (NaF) and ¹⁸F-fluorodeoxyglucose (FDG) to evaluate for the presence and degree of atherosclerosis in the aorta, carotid arteries, coronary arteries, iliac arteries, and the femoral arteries. Elevated NaF uptake within the bilateral carotid arteries signified substantial ongoing vascular microcalcification. Reduced global brain metabolism and region-specific hypometabolism measured with FDG PET indicated potential cerebrovascular mechanisms that may be influencing neurological function. The findings highlight the potential of emerging PET tracers, such as NaF, to improve the diagnostic accuracy and therapeutic management of CVD. This case emphasizes the importance of a comprehensive diagnostic approach as well as continued investigation into CVD pathophysiology using PET-based techniques, which may guide the development of innovative therapeutic strategies. Full article

Background: Previous studies suggest variability in the management of cardiogenic shock (CS). Methods: An anonymous survey was sent to Spanish hospitals. Results: We obtained 50 answers, mainly from cardiologists (36–72%). The annual average of ECMOs is 16.7 ± 11.3 applications in CS patients and of Impellas is 8.7 ± 8.3 applications in CS patients. Intra-aortic balloon counterpulsation is used in the majority of CS ECMOs (31–62%), and Impella is used in 7 (14%). In 36 (72%) cases, ECMO is used as a treatment for cardiac arrest. In 10 cases, ECMO removal is percutaneous (20%). In 25 (50%) cases, age is a relative contraindication; 17 have a mobile ECMO team (34%); and 23 (46%) have received ECMO patients from other centers in the last year. Pre-purged ECMO is only used in 16 (32%). ECMO implantation is carried out under ultrasound guidance in 31 (62%), only with angiography in 3 (6%) and with both in 11 (22%). The Swan–Ganz catheter is used routinely in 8 (16%), only in doubtful cases in 24 (48%), and in most cases in 8 (16%). The ECMO awake strategy is used little or not at all in 28 (56%), in selected cases in 17 (34%), and routinely in 5 (10%). Conclusion: Our study shows a huge variation in the management of patients with CS. Full article

Metalloproteinases (MPs) belong to the superfamily of zinc endopeptidases, which are called metzincins. Three families of MPs have been studied in healthy and diseased conditions in humans. The first study on MPs was published in 1962, and following that, several studies characterized their activity and their effect on health and disease. Several diseases have been related to MPs, such as cardiovascular disease, cancer, inflammatory diseases, gynecological disorders, and others. Moreover, tissue inhibitors of metalloproteinases (TIMPs) have been widely studied, and drugs and artificial molecules that could target MP activity have been evaluated. MPs are relevant to public health because of their role in several diseases and, most of all, their role as biomarkers that also impact the quality of life and the psychosocial dimension of affected patients. In this context, new pathways to precision health and precision medicine have been opened in the area of MPs. This review describes, from the initial studies, the complex dimensions of MPs and related issues centered on health and disease dimensions. Full article

Numerous studies have investigated in-stent restenosis (ISR) predictors in first-generation drug-eluting stents (DESs), but only a few have investigated second-generation DESs. We aimed to investigate the ISR predictors following a successful DES implantation in coronary artery disease (CAD) patients. A systematic review and meta-analysis study was conducted. Diabetes mellitus (DM) (OR 1.47; 95% CI 1.19 to 1.83; p < 0.01), family history of CAD (OR 1.26; 95% CI 1.03 to 1.55; p 0.03), and smoking (OR 1.23; 95% CI 1.02 to 1.48; p 0.03) were the strong predictors for the DES-ISR. The DES-ISR was more common in DESs with smaller stent diameter (MD −0.12; 95% CI −0.16 to −0.08; p < 0.01) and longer stent length (MD 2.24; 95% CI 1.36 to 3.13; p < 0.01). Angiography characteristics, including multi-vessel disease (MVD) (OR 1.45; 95% CI 1.07 to 1.97; p 0.02), type B2/C lesions (OR 1.56; 95% CI 1.06 to 2.30; p 0.02), and type C lesion (OR 1.33; 95% CI 1.09 to 1.62; p < 0.01), were also associated with DES-ISR. We confirmed that DM, family history of CAD, smoking, MVD, smaller stent diameter, longer stent length, and type B2 or C lesions were proven to be ISR predictors following DES implantation. Full article

Motor imagery (MI) and action observation (AO) techniques are two movement representation strategies that are widely used in multiple fields of study. MI is defined as the cognitive skill that involves the representation of an action, internally, without actual motor execution. AO training evokes internally, and in real time, a simulation of the actual motor gestures that the observer is visually perceiving. Both cognitive processes cause an activation of the brain areas related to the planning, adjustment, and automation of voluntary movement in a similar way as when the action is carried out in a real way. Movement representation strategies have shown that they can be a very useful complement to physical practice to improve some particularly relevant aspects in neurological and musculoskeletal patients. In this narrative review, we discuss the effect that the implementation of these motion representation strategies might have on patients with cardiovascular disease. At the cardiovascular level, MI and AO training should be considered as interventional tools for the management of these patients. With these clinical tools, we could try to improve the generation of cardiopulmonary adaptations, improve exercise tolerability, and also increase functionality. However, more research is needed in this field where these clinical tools are combined with cardiac rehabilitation programs to see if the clinical effect is greater than cardiac rehabilitation programs in isolation. Full article

Background: Vein of Galen malformation (VGM) is a congenital intracranial vascular anomaly consisting of arteriovenous fistulas and/or malformations between various arterial feeders and the median prosencephalic vein of Markowski (MPV). Despite its rare occurrence, VGM is of particular clinical relevance, as the excessive intracranial shunt volume leads to high mortality without appropriate treatment. Methods: The objective of this article is to review the published data on neurointerventional treatment and compare outcome quality in the included studies. Eight studies were included and synthesized. One study was multicentric and the rest were retrospective monocentric (level 4 evidence studies according to the Oxford Centre for Evidence-based Medicine). Results: The total number of included patients was 480 and patient age ranged from 1 day to 18 years. Mild or severe heart failure, hydrocephalus, and other reasons led to the indication for neurointerventional treatment, which was performed in all studies in the form of embolization. Under consideration of the introduced semiquantitative multidimensional scoring system, the highest total score, i.e., the best outcome quality, was found for the study “Houston” 2002–2018 (19 points) and the study “Duisburg” 2001–2010 (19 points). Conclusions: Neurointerventional treatment represents the essential pillar in the interdisciplinary management of patients with VGM, although standardization is lacking—based on the results of the structured review. As complementary treatments, pediatric critical care is mandatory and includes medical hemodynamic stabilization. Full article