To evaluate the diagnostic accuracy of photon-counting coronary CT angiography (PCCT-CCTA) for assessing coronary artery stenosis, using invasive coronary angiography (ICA) as the reference standard. 90 adult patients who underwent PCCT-CCTA followed by consecutive ICA were included in this retrospective single-center study. PCCT-CCTA examinations were performed in standard-resolution or ultra-high resolution. Image quality, coronary stenosis severity, and CAD-RADS 2.0 classifications were assessed by blinded experienced radiologists. ICA findings served as the reference standard. Statistical analyses included Wilcoxon signed-rank testing, Spearman correlation, ROC analysis, and calculation of overestimation, underestimation, and concordance rates. The overall image quality was excellent (median Likert score 5). PCCT-CCTA demonstrated high sensitivity and negative predictive value for identifying patients requiring invasive therapy at a CAD-RADS score >3, but the specificity was low. PCCT-CCTA significantly differed from ICA in stenosis grading (p = 0.001) and showed a tendency to overestimate stenosis severity, particularly in mild to moderate lesions. The overall overestimation rate was 66.8%, the underestimation rate was 9.3%, and the concordance rate was 23.9%. Ultra-high resolution improved the detection of severe stenoses but did not eliminate overestimation. The CAD-RADS score demonstrated limited discriminatory performance for therapy prediction (AUC 0.581). No significant correlations were found between Agatston score, CAD-RADS 2.0 classification, and image quality. PCCT-CCTA reliably identifies patients requiring invasive coronary therapy but tends to overestimate stenosis severity compared with ICA. Despite this limitation, PCCT-CCTA represents a valuable noninvasive gatekeeper for invasive coronary angiography. · PCCT-CCTA reliably identifies patients requiring invasive coronary therapy.. · Ultra-high resolution improves severe stenosis detection but not specificity.. · Calcium score does not predict stenosis severity.. · Haag NP, Katz MS, Wiemer M et al. The Accuracy of Photon-Counting CT Angiography of the Coronaries Compared to Invasive Coronary Angiography. Rofo 2026; DOI 10.1055/a-2901-9309. Das Ziel dieser Studie war die Untersuchung der diagnostischen Genauigkeit der Photon-counting CT-Koronarangiografie (PCCT-CCTA) zur Beurteilung von Koronararterienstenosen im Vergleich zum Goldstandard, der invasiven Koronarangiografie (ICA).In diese retrospektive Single-Center-Studie wurden 90 erwachsene Patienten eingeschlossen, die eine PCCT-CCTA mit anschließender ICA erhielten. Die PCCT-CCTA wurden entweder in Standardauflösung oder Ultra-Hoch-Auflösung durchgeführt. Die Beurteilung der Bildqualität, des Schweregrades der Koronarstenosen sowie der CAD-RADS-2.0-Klassifikation erfolgte durch verblindete, erfahrene Radiologen und wurde mit den ICA-Befunden verglichen. Die statistische Auswertung umfasste den Wilcoxon-Vorzeichen-Rang-Test, die Spearman-Korrelationsanalyse, eine ROC-Analyse sowie die Berechnung von Über-, Unter- und Übereinstimmungsraten.Die Gesamtbildqualität war exzellent (medianer Likert-Score 5). Die PCCT-CCTA zeigte eine hohe Sensitivität zur Identifikation von Patienten mit invasivem Therapiebedarf bei einem CAD-RADS-Score >3, jedoch eine geringe Spezifität. Die Bestimmung des Stenosegrades unterschied sich signifikant zwischen PCCT-CCTA und ICA (p=0,001), wobei die PCCT-CCTA insbesondere bei milden bis moderaten Läsionen zu einer Überschätzung der Stenose tendierte. Die Gesamtüberschätzungsrate betrug 66,8%, die Unterschätzungsrate 9,3% und die Übereinstimmungsrate 23,9%. Ultra-Hoch-Auflösung verbesserte die Detektion hochgradiger Stenosen. Der CAD-RADS-Score zeigte lediglich eine eingeschränkte Vorhersage einer Therapiebedürftigkeit (AUC 0.581). Es fanden sich keine signifikanten Korrelationen zwischen Agatston-Score, CAD-RADS-2.0-Klassifikation und Bildqualität.Die PCCT-CCTA zeigt eine hohe Zuverlässigkeit in der Identifikation von Patienten mit invasivem Therapiebedarf, neigt jedoch im Vergleich zur ICA zur Überschätzung des Stenosegrades. Trotz dieser Limitation stellt die PCCT-CCTA ein wertvolles, nicht-invasives Selektionsinstrument zur Evaluation der Koronararterien dar. · Die PCCT-CCTA identifiziert zuverlässig Patienten, die eine invasive Therapie der Koronararterien benötigen.. · Ultra-Hoch-Auflösung verbessert die Erkennung hochgradiger Stenosen, jedoch nicht die Spezifität.. · Der Kalziumscore sagt nicht den Schweregrad einer Stenose voraus..
Pericoronary adipose tissue (PCAT) reflects local coronary inflammation and microstructural changes and may predict major adverse cardiac events (MACE). Radiomics extracts high-dimensional features from PCAT on coronary CT angiography, capturing tissue heterogeneity beyond conventional risk factors or plaque metrics. This study evaluated the diagnostic performance of PCAT radiomics for MACE prediction. PubMed, Scopus, and Web of Science were searched from inception to October 2025. Ten retrospective studies were included. Diagnostic metrics were extracted and pooled using random-effects models. Subgroup analyses were performed by classifier, region of interest, and follow-up duration. Methodological quality and certainty of evidence were assessed. Radiomics-only models showed moderate performance (sensitivity 0.70, specificity 0.74, area under the curve (AUC) 0.78). Combined models improved discrimination, with radiomics + clinical (AUC 0.80) and radiomics + imaging (sensitivity 0.89; diagnostic odds ratio (LnDOR) 2.93). Triple-combination models achieved the highest performance (AUC 0.87; LnDOR 4.05). Radiomics models showed higher AUC than clinical (ΔAUC = 0.05) and imaging models (ΔAUC = 0.18), with inconsistent sensitivity and specificity differences. Adding clinical variables provided modest improvement, whereas imaging integration yielded greater gains. Triple models showed the largest improvement (ΔAUC = 0.06; ΔLnDOR = 2.21). Mean Radiomics Quality Score was 18/36, and overall evidence certainty was moderate. PCAT radiomics derived from CCTA shows moderate predictive performance for MACE in patients with coronary artery disease and may provide incremental value over conventional clinical and imaging models. Standardized radiomics pipelines and multicenter prospective validation are required for clinical translation. Question Can quantitative analysis of pericoronary adipose tissue on coronary computed tomography angiography improve the prediction of major adverse cardiac events beyond clinical risk factors? Findings Radiomics models showed higher AUC than clinical and imaging models, while combined models demonstrated the highest predictive performance across included studies. Clinical relevance Pericoronary adipose tissue radiomics may provide additional quantitative information on coronary inflammation and may offer potential incremental value for risk prediction in patients undergoing coronary computed tomography angiography. However, further external validation and standardization are required before clinical implementation.
Purpose To evaluate anatomy-specific diagnostic performance of CT angiography-based artificial intelligence (AI) for anterior circulation occlusion detection and negative-result implications for distal occlusions. Materials and Methods In this Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Diagnostic Test Accuracy Studies (PRISMA-DTA)-compliant, prospectively registered systematic review and diagnostic meta-analysis, PubMed, Embase, and Web of Science were searched for AI-based CT angiography studies from January 1, 2019, through March 11, 2026. Pooled sensitivity and specificity were estimated for global large-vessel occlusions (LVOs), combined internal carotid artery/first segment of the middle cerebral artery (ICA/M1) occlusions, and distal second/third segments of the middle cerebral artery (M2/M3) occlusions with a bivariate random-effects model. Evidence certainty was assessed with GRADE; a supportive record-level multilevel bivariate generalized linear mixed model (GLMM) adjusted for occlusion territory, study design, algorithm type, publication year, and section thickness. Results Thirty-one reports involving 15,708 patients were included. Pooled sensitivity/specificity were 80.1%/91.9% for global LVOs, 91.6%/92.7% for ICA/M1 occlusions, and 52.7%/94.8% for M2/M3 occlusions. In the supportive adjusted model, ICA/M1 occlusions had higher sensitivity than global LVOs (OR, 2.28; P < .001), whereas M2/M3 occlusions had lower sensitivity (OR, 0.25; P < .001). Evidence certainty was moderate for ICA/M1 sensitivity and very low for M2/M3 sensitivity. For M2/M3 occlusions, a negative AI result yielded an LR- of 0.50 (95% CI, 0.28-0.73), corresponding to posttest probabilities of 17.6% and 33.3% at 30% and 50% pretest probabilities. Conclusion CT angiography-based AI performance varied by occlusion territory; lower M2/M3 sensitivity limited negative-result reliability. ©RSNA, 2026.
Moyamoya disease is a rare progressive cerebrovascular disorder characterized by stenosis of the terminal internal carotid arteries and compensatory development of fragile basal collateral vessels. We report a 32-year-old Filipino woman with poorly controlled hypertension who presented with abrupt right facial and upper limb weakness followed by recurrent left hemispheric ischemic events despite antiplatelet therapy, statin treatment, and blood pressure optimization. Magnetic resonance imaging showed recurrent left-sided watershed and cortical infarcts, while magnetic resonance angiography suggested bilateral terminal internal carotid artery stenosis with collateralization. Digital subtraction angiography confirmed bilateral distal internal carotid artery tapering, bilateral M1 involvement, and prominent collateral revascularization, consistent with moyamoya disease. CT perfusion demonstrated left hemispheric hemodynamic compromise with delayed perfusion and relatively preserved cerebral blood volume, supporting prioritization of left-sided superficial temporal artery-to-middle cerebral artery bypass, with staged contralateral reassessment planned after postoperative recovery. This case emphasizes that recurrent ischemic events in young adults should prompt evaluation for moyamoya disease and illustrates the complementary role of digital subtraction angiography and CT perfusion in diagnosis, mechanism clarification, and individualized bypass planning.
Imaging-guided percutaneous coronary intervention (PCI) improves outcomes, but the clinical utility of near-infrared spectroscopy (NIRS) remains unclear. The aim of the study was to evaluate whether multimodality imaging with NIRS, intravascular ultrasound (IVUS) and optical coherence tomography (OCT) would improve stent strut coverage compared with angiography-guided PCI in patients with acute myocardial infarction (MI) and further to assess the impact of lipid-rich plaque (LRP) on vascular healing. A total of 104 patients with MI were randomized to imaging- or angiography-guided PCI. NIRS-IVUS imaging was performed pre- and post-PCI, and OCT post-PCI and at 6-month follow-up. Maximum lipid core burden index in a 4-mm segment (maxLCBI4 mm) was measured. The primary endpoint was percentage of covered stent struts (OCT) at 6-month follow-up. Pre-PCI maxLCBI4 mm was similar in the two groups (441 [239, 565] vs. 333 [242, 517], p = 0.19). Imaging guidance resulted in a larger minimal stent area (7.3 ± 2.4 mm2 vs. 6.5 ± 1.7 mm2, p = 0.04). At 6-month follow-up, stent strut coverage was higher in the imaging group (86.9% [77.7, 93.7] vs. 74.4% [53.8, 81.8], p < 0.001). Segment-level analyses showed that LRP without superficial attenuation and suboptimal stent expansion was associated with higher percentage of intima hyperplasia (23.4% [20.5, 25.9] vs. 13.9% [10.6, 16.0], p < 0.001) compared to optimal stent expansion, whereas LRP with attenuation and suboptimal stent expansion was associated with higher rates of late-acquired stent malapposition (81.8% vs. 30.0%, p = 0.02) compared to optimal stent expansion. Imaging-guided PCI improved stent strut coverage. LRP phenotypes were associated with different healing patterns. Clinical Trial Registration Information: URL: https://www. gov; Unique identifier: NCT04460482.
Calcified nodules (CN) and nodular calcifications (NC) present significant challenges during percutaneous coronary intervention (PCI) because of their protruding morphology and high rigidity, which often result in inadequate stent expansion and suboptimal procedural outcomes. This single-center retrospective study investigated whether coronary computed tomography angiography (CCTA)-derived mean density could predict stent expansion outcomes in CN/NC lesions identified using intravascular ultrasonography (IVUS). Forty-nine target vessels in 46 patients who underwent IVUS-guided PCI within 1 year of CCTA were analyzed. Univariate and multivariate linear regression analyses were performed to evaluate the associations between CCTA-derived calcification parameters, IVUS-derived stent expansion, and stent symmetry index. Group-based comparisons and receiver-operating characteristic curve analyses were performed as secondary analyses to identify poor stent expansion (< 90%). Mean density was significantly associated with stent expansion in both univariable analysis and the multivariable mean density model adjusted for calcium arc, calcium thickness, and rotational atherectomy (β = -0.085; 95% confidence interval [CI], -0.152 to -0.019; p = 0.013). Mean density showed a moderate inverse correlation with both stent expansion (r = -0.415, p = 0.003) and the stent symmetry index (r = -0.292, p = 0.042). In the secondary analyses, receiver operating characteristic curve analysis indicated that a cutoff value of 514.93 Hounsfield units yielded an area under the curve of 0.80 in non-atherectomy cases. These findings suggest that CCTA-derived mean density may help guide lesion-specific interventional strategies and serve as a valuable, noninvasive preprocedural marker for assessing the mechanical difficulty of CN/NC lesions.
To characterize duration-dependent topographic macular neurovascular unit (NVU) alterations in type 2 diabetes (T2DM) without diabetic retinopathy (DR) using 26×21 mm ultra-widefield swept-source OCT angiography (UWF-SS-OCTA) and evaluate its diagnostic utility for long-duration eyes. This cross-sectional study included 295 eyes (69 controls; 226 T2DM without DR stratified by duration: <5, 5-10, ≥10 years). The superficial vascular density (SVD), deep vascular density (DVD), superficial macular vascular density (SMVD), and nerve-fibre-layer microvascular density (NFMVD) were quantified in the fovea (1 mm), inner (1-12 mm) and outer (12-21 mm) rings and their quadrants. Ganglion cell-inner plexiform layer (GCIPL) thickness was derived from the 26 × 21 mm OCTA scan. ANCOVA adjusted for age, sex, BMI, hypertension, IOP with false discovery rate correction, multivariable regression, and ROC/decision curve analyses were used. Longer duration was associated with progressive GCIPL thinning and deep-predominant DVD reduction across nearly all macular zones (q<0.05); the DVD deficit was most pronounced in the outer ring. SVD showed nasal-temporal asymmetry; selective nasal inner loss in ≥10-year group. GCIPL-DVD coupling, present in controls, attenuated in ≥10-year group, indicating NVU decoupling. Duration independently predicted GCIPL (β=-0.21) and DVD (β=-0.27) after adjustment (P<0.01). DVD alone discriminated ≥10-year eyes from controls (AUC 0.723, 95% CI 0.63-0.81); addition of GCIPL did not improve AUC (0.724, P>0.05). Decision curve analysis confirmed net clinical benefit. Preclinical NVU decoupling-predominantly in the deep capillary plexus and nasally asymmetric-already occurs in T2DM without fundoscopic DR and progresses with disease duration. Deep-layer UWF-SS-OCTA metrics may strengthen risk stratification before clinical retinopathy.
Osteoporosis and atherosclerosis are prevalent diseases that exert significant impacts on morbidity and mortality. To investigate the relationship between opportunistically measured thoracic vertebral bone mineral density (BMD) on coronary computed tomography angiography (CCTA) and coronary artery disease (CAD), coronary artery stenosis severity and coronary artery calcium score (CACS). This retrospective study included 386 patients undergoing CCTA for suspected CAD. BMD was measured on non-contrast images using Hounsfield units (HU), and values < 200 HU were defined as low BMD. Coronary artery stenosis, vessel involvement and CACS were evaluated. Logistic and linear regression analyses were performed to assess associations between BMD, CAD and CACS. Among 386 patients (55.7% male, mean age 51.5 ± 11.4 years), CAD was detected in 49 (12.7%). Low BMD was significantly more frequent in patients with CAD and was independently associated with its presence (OR = 2.98, p = 0.003). The prevalence of coronary artery stenosis was significantly higher in the low BMD group, including LMCA (10.9% vs. 1.9%), LAD (45.0% vs. 20.4%), RCA (27.9% vs. 12.1%) and Cx (20.1% vs. 10.8%) (p < 0.05 for all). Moderate and severe CACS were also more common in patients with low BMD (p < 0.001). BMD showed a significant negative association with CACS. Lower thoracic vertebral BMD is independently associated with the presence and severity of CAD and higher coronary calcium burden. Opportunistic BMD assessment on routine CCTA may serve as a complementary imaging biomarker reflecting overall cardiometabolic risk.
To evaluate the relationship between physical activity (PA) and choroidal circulation in older adults with primary open-angle glaucoma (POAG) using swept-source optical coherence tomography angiography (SS-OCTA). This cross-sectional study included participants aged 60 years or older from the Elderly Glaucoma and Sleep Study, comprising both patients with POAG and age-matched controls. PA was assessed using the International Physical Activity Questionnaire and a wrist-worn actigraphy device worn continuously for ≥7 days. PA parameters included total PA (metabolic equivalent task minutes per week), daily step count, moderate-to-vigorous physical activity (MVPA) duration, and total energy expenditure. After the monitoring period, SS-OCTA imaging was performed on all participants using a 6-mm × 6-mm macular scan to quantify choroidal vascular volume (CVV), choroidal stromal volume, choroidal vascularity index, and choriocapillaris flow density (CC FD). Associations between PA and choroidal parameters were analyzed using multivariable linear regression. Older adults with POAG engaged in substantially lower levels of PA, particularly MVPA, and showed reduced CVV and CC FD compared with age-matched controls (all P < 0.05). Among patients with POAG, longer MVPA duration was independently associated with greater CVV (β = 0.04, P = 0.021) and higher CC FD (β = 0.06, P = 0.004). Older adults with POAG showed reduced habitual PA levels and impaired macular choroidal circulation. Longer MVPA duration was associated with better macular choroidal circulation in older adults with POAG. MVPA may represent a modifiable factor relevant to choroidal circulation health in glaucoma.
This study aimed to characterize the central retinal and choroidal vasculature in adults with a history of retinopathy of prematurity (ROP). In this cross-sectional study, adults with history of ROP were compared to full-term controls using macular 6 × 6-mm and 12 × 12-mm swept-source optical coherence tomography angiography (OCTA) (PLEX Elite 9000). Vessel density (VD) and vessel skeletonized density (VSD) were quantified in the superficial capillary plexus, deep capillary plexus (DCP), and whole retina. Foveal avascular zone (FAZ) metrics, mean choroidal thickness (MCT), and choroidal vascularity index (CVI) were also analyzed. Linear mixed-effects models adjusted for age and nesting estimated group differences for global and sector-level outcomes. A secondary exploratory analysis was conducted to compare treated versus untreated ROP eyes. Twenty-three eyes from 13 adults with ROP and 19 eyes from 15 controls were included. ROP eyes showed significantly lower VD and VSD across all layers on both scan sizes (all P < .05), with largest effects in the DCP. Sector maps revealed widespread deficits that preferentially involved inferior and temporal regions. On 6 × 6-mm scans, FAZ area, circularity, and perimeter were smaller in ROP (all P < .05). On 12 × 12-mm scans, CVI was reduced in ROP (P = .048), while MCT did not differ. Previously treated ROP eyes had lower VD and VSD compared to untreated ROP eyes (all P < .05). Adults with a history of ROP exhibit persistent retinal microvascular loss and decreased choroidal vascularity. OCTA can be used to assess sub-clinical abnormalities and as a future outcome measure when comparing ROP treatment modalities.
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Vascular injury following blunt pelvic fractures is a major source of morbidity and mortality. Angioembolization has become the standard of care for patients with contrast extravasation (CE) on CT scan; however, there are patients without CE who have a vascular injury. We aimed to determine the predictors of the need for angioembolization in patients with blunt pelvic fractures. We performed a retrospective case-control study of blunt trauma patients with pelvic fractures who underwent angiography by interventional radiology (IR) at a single institution from 2018 to 2023. Patients with CE on CT scan were compared with patients without CE to determine the risk factors for a positive angiogram. A multivariable logistic regression analysis was conducted to assess the factors associated with having a positive angiogram. 167 patients with blunt pelvic fractures underwent angiography: 120 with CE and 47 without CE on CT scan. Both groups were severely injured with a mean Injury Severity Score of 31; over 85% of patients requiring blood prior to angiography and 45% requiring massive transfusion protocol (MTP). There was no difference in rates of positive angiogram between patients with and without CE on CT scan (83% vs. 93%, p=0.08). Of the 47 patients without CE on their CT scan, 27 (57%) had active extravasation on angiography and an additional 12 (26%) had an injury requiring intervention. Initial systolic blood pressure, receiving blood prior to angiography, MTP activation, and CE on initial CT scan were not independently predictive of positive angiogram. Although CE on CT scan is often the initial trigger for IR consultation for angiography in trauma patients with pelvic fractures, there are patients without CE who have an injury requiring intervention. In trauma patients with concerns for ongoing hemodynamic instability, IR consultation is reasonable even without CE on initial CT scan. Diagnostic test/criteria: level IV.
Kounis syndrome, or allergic acute coronary syndrome, is a potentially underdiagnosed condition triggered by hypersensitivity reactions. Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently implicated, with diclofenac repeatedly reported as a precipitating agent. However, no systematic synthesis has specifically evaluated the clinical characteristics, management, and outcomes of diclofenac-induced Kounis syndrome. We conducted a systematic review of case reports and case series describing diclofenac-associated Kounis syndrome, searching PubMed/MEDLINE, Scopus, and Google Scholar from inception through January 31, 2026. Eligible studies documented a temporal association between diclofenac exposure and acute coronary events with allergic manifestations. Data on demographics, clinical presentation, diagnostic findings, management, and outcomes were extracted. Methodological quality was assessed using a modified CARE checklist framework. Data were synthesized descriptively. Additionally, we carried out disproportionality analysis of reported events with Kounis syndrome and diclofenac from the United States Food and Drug Administration Adverse Event Reporting System (FAERS). Twenty-seven patients were included. The majority were male (81.5%), and 44.4% had no cardiovascular comorbidities. Allergic manifestations included hypotension (70.4%), urticaria (66.7%), and chest pain (85.2%). Type I Kounis syndrome (vasospasm without underlying coronary disease) was most common (59.3%), followed by type II (25.9%) and type III (3.7%). ST-segment elevation was present in 66.7%, and coronary angiography was normal in 63.0%. Management consisted of antihistamines (85.2%), corticosteroids (77.8%), and epinephrine (37.0%). Percutaneous coronary intervention was performed in 11.1%. Causality was probable or definite in all cases. All patients survived discharge. Quality assessment revealed high-quality reporting in 70.4% of cases, though documentation of patient perspective and informed consent was universally absent. FAERS analysis revealed positive signals between diclofenac and Kounis syndrome from 137 reports. Diclofenac-induced Kounis syndrome most commonly presents as type I vasospastic myocardial ischemia with prominent allergic features, ST-segment elevation, and normal coronary angiography. Outcomes are favorable with prompt recognition and combined anti-allergic and anti-ischemic therapy. Clinicians should maintain a high index of suspicion following diclofenac exposure, even in patients without cardiovascular risk factors, and strict avoidance of re-exposure is essential.
This report describes an especially rare postoperative pseudoaneurysm of the sphenopalatine artery following midface advancement using Le Fort III in an Apert syndrome patient. The Apert patient referenced in this report was a 13-year-old boy with severe midface hypoplasia, significant obstructive sleep apnea, and Angle Class III malocclusion. The patient underwent a low Le Fort III osteotomy, subsequently followed by gradual anterior distraction with an external halo distractor. One month postoperatively, the patient experienced recurrent, massive blood loss due to unilateral epistaxis. In order to immediately address life-threatening hemorrhaging and maintain advanced segment stability, the external distractors were removed, and a custom protraction face mask was applied for retention. A computerized tomography angiography showed a 4×3 mm saccular pseudoaneurysm from a branch of the left sphenopalatine artery in the pterygopalatine fossa near the posterior maxillary sinus wall. Careful microcatheterization and embolization achieved complete occlusion with preservation of adjacent collateral flow, resulting in immediate and sustained cessation of epistaxis, hemoglobin stabilization, and recovery without further complication. After 12 weeks of protraction face mask retention, achieved midface advancement remained stable; there was no recurrent bleeding over the next 6 months, and the patient's occlusion was classified as Angle Class II. This case underscores that recurrent severe postoperative epistaxis occurring after Le Fort III distraction requires immediate computerized tomography angiography to detect pseudoaneurysm and supports endovascular embolization as a safe, minimally invasive, highly effective first-line therapy within a multidisciplinary care model.
Dural arteriovenous fistulas (dAVFs) involving the optic nerve sheath are rare and often present subtly. We report a case of a woman in her 50s with a month-long history of left eye redness, swelling and watering. Examination revealed proptosis and chemosis without vision loss or cranial nerve deficits. MRI showed a dilated superior ophthalmic vein (SOV), initially suggesting a carotico-cavernous fistula. However, digital subtraction angiography confirmed a slow-flow intraorbital dAVF supplied by the left ophthalmic and accessory meningeal arteries, draining via the SOV. Conservative management with carotid compression failed, and after 1 year, worsening symptoms and thrombosed venous outflow precluded standard endovascular access. A direct ultrasound-guided SOV puncture was performed using a micropuncture needle. Embolisation with detachable coils and Menox 18 achieved complete fistula occlusion, with clinical improvement. This case highlights the role of catheter angiography in diagnosing intraorbital dAVFs and demonstrates the feasibility of direct SOV puncture when conventional routes are inaccessible.
Transradial access is the preferred approach for coronary interventions, but vascular complications may rarely lead to unexpected coronary events. A 50-year-old woman with cardiovascular risk factors presented with exertional symptoms and a positive stress echocardiography result in the anterior territory. Coronary angiography via right radial access revealed a significant mid-left anterior descending coronary artery lesion. During ad hoc percutaneous coronary intervention (PCI), difficult catheter advancement due to radial resistance and spasm required escalation to a long guide sheath. After guidewire placement, angiography revealed a new hazy filling defect at the proximal left anterior descending coronary artery-left circumflex coronary artery bifurcation, associated with chest pain and ST-segment elevation. Thromboaspiration restored coronary flow, retrieving a 3-cm vascular fragment. Histopathology confirmed an avulsed radial arterial wall fragment containing the 3 layers of the vascular wall. Upper limb imaging showed preserved radial flow. This case illustrates coronary embolization secondary to radial arterial wall injury during transradial PCI. Difficult catheter advancement during transradial PCI may cause radial arterial wall avulsion with subsequent coronary embolization. Unexpected angiographic filling defects should prompt consideration of nonthrombotic embolic mechanisms and rapid bailout strategies.
Drug-coated balloons are an emerging strategy for coronary revascularization. Despite their increasing use, the comparative efficacy of sirolimus-versus paclitaxel-coated balloons (SCB vs PCB) remains uncertain. This updated meta-analysis evaluated clinical and angiographic outcomes of SCB and PCB in percutaneous coronary intervention (PCI). A comprehensive search of PubMed, Scopus, and ScienceDirect was performed on August 28, 2025. Studies directly comparing SCB and PCB were included. The primary endpoint was target lesion failure (TLF), which was defined as cardiac death, target vessel myocardial infarction (TVMI), or target lesion revascularization (TLR). On follow-up angiography, secondary endpoints consisted of minimal lumen diameter (MLD), late lumen loss (LLL), and diameter stenosis. Pairwise meta-analyses, subgroup analyses, and sensitivity analyses were performed. The certainty of evidence was evaluated with GRADE. Thirteen studies with 5947 patients (4097 SCB and 1850 PCB) were analyzed. SCB and PCB showed no significant differences in TLF (RR 1.10, 95% CI 0.84 to 1.44), cardiac death (RR 1.19, 95% CI 0.56 to 2.53), TLR (RR 1.12, 95% CI 0.91 to 1.37), and TVMI (RR 1.82, 95% CI 0.58 to 5.72). Subgroup analyses by lesion type and study design were consistent. Angiographic outcomes were comparable between groups, except for smaller insegment MLD with SCB (MD -0.10 mm, 95% CI -0.18 to -0.02; p = 0.01), although this finding was not robust in sensitivity analysis. Certainty of evidence was moderate for clinical outcomes and low to moderate for angiographic outcomes, primarily downgraded due to imprecision and inconsistency. In conclusion, SCB and PCB demonstrated comparable efficacy in PCI, with no significant differences in clinical and angiographic endpoints, irrespective of lesion types.
Particulate matter (PM) is known to accelerate atherosclerosis through systemic inflammation, yet its specific impact on local coronary inflammation remains poorly understood. This large-scale retrospective cohort study investigated the long-term effects of PM exposure on coronary inflammation as assessed by the pericoronary fat attenuation index (FAI). We analyzed 5,528 participants undergoing coronary computed tomography angiography (CCTA), including a longitudinal subcohort of 656 individuals with serial scans. FAI values for the left anterior descending, left circumflex, and right coronary arteries were extracted using a deep-learning-based pipeline. Individual-level exposures to fine particulate with an aerodynamic diameter <2.5μm (PM2.5), particulate matter with an aerodynamic diameter of less than 10μm (PM10), and black carbon (BC) were estimated using a validated 1-km resolution spatiotemporal model. Results from generalized additive and linear mixed-effects models indicated that each interquartile range (IQR) increase in 1-year PM2.5, PM10, and BC exposure was associated with significant elevations in FAI across all vessels, such as increases of 7.57, 8.72, and 2.35 HU in the right coronary artery, respectively. Furthermore, longitudinal analysis revealed that IQR increases in pollutants corresponded to accelerated annual FAI progression. These associations were notably stronger among participants with hypertension, diabetes, or a history of smoking. In conclusion, among patients with suspected coronary artery disease, long-term exposure to PM is intrinsically linked to localized and progressive coronary inflammation. These findings provide a proximal toxicological link between ambient pollution and coronary pathophysiology, underscoring the urgency of integrating environmental determinants into cardiovascular risk assessment and prevention strategies for vulnerable populations.