Cardiovascular disease (CVD) accounts for a third of all deaths, making it the leading cause of mortality globally. Coronary microvascular dysfunction (CMD) has emerged as a prominent condition in menopausal women, leading to the development of chronic coronary syndrome (CCS). Despite the significant impact on this cohort, research gaps persist which can lead to shortcomings in the delivery of care to women. CMD is more prevalent in women than men and is linked to increased risk of major adverse cardiovascular events and mortality. During the menopausal transition, there is an acceleration in vascular ageing due to hormonal shift and metabolic changes, resulting in endothelial dysfunction. A large proportion of patients with Takotsubo syndrome and heart failure with preserved ejection fraction (HFpEF) are menopausal women with CMD; however, the underlying mechanisms are not fully understood. Limited evidence of the sex-specific pathophysiology of CMD has resulted in current clinical practice relying on evidence from male-dominant or mixed cohorts. This can lead to incorrect risk stratification, treatment side effects and poor prognosis in women. In addition, there is limited research on the efficacy of diagnostic techniques addressing the sex differences in those with CMD. Tailored diagnostic thresholds and models are essential to improve prognosis in women. Further evidence is needed to bridge these knowledge gaps to tackle the sex differences, achieve sex equality in CVD research and reduce the disproportionate burden of microvascular dysfunction in menopausal women.
Vascular diseases, particularly atherosclerosis, represent a leading cause of global morbidity and mortality. Endovascular stenting has emerged as a cornerstone of therapy to restore vessel patency, yet conventional stents remain obstructed by significant clinical limitations, including in-stent restenosis, thrombosis, and mechanical failure. These adverse outcomes are intrinsically linked to their fundamental structural design, which is characterized by a positive Poisson's ratio, leading to foreshortening and a biomechanical mismatch with the native vasculature. This review critically examines auxetic stents as a next-generation solution, engineered with a structure possessing a negative Poisson's ratio. This unique property allows them to expand axially upon radial deployment, thereby eliminating foreshortening, enhancing conformability to tortuous vessels, and distributing mechanical stress more uniformly onto the arterial wall. This paper synthesizes the robust body of in-silico/bench-top evidence from computational modeling and in-vitro experimentation that validates these superior biomechanical characteristics. Furthermore, it explores the profound and favorable biological implications, arguing that the optimized mechanical environment and improved hemodynamics are hypothesized to attenuate the primary triggers for neointimal hyperplasia and foster rapid, complete endothelialization. The review concludes by outlining the translational pathway, including challenges in structure integration and discussing the vast future horizons for auxetic structured stents in complex peripheral, carotid, and non-vascular applications. Auxetic design represents a paradigm shift from material-centric iteration to structure-driven innovation, holding the promise to significantly improve the long-term safety and efficacy of endovascular stent implants.
To evaluate early and midterm outcomes of intravascular lithotripsy (IVL)-assisted endovascular treatment for severely calcified femoropopliteal disease in patients with chronic limb-threatening ischemia (CLTI). This retrospective, single-center, single-arm study included 43 consecutive Rutherford class 4-6 CLTI patients treated between June 2023 and April 2025. Severe calcification was defined as Peripheral Arterial Calcium Scoring System (PACSS) grade 3 or 4. IVL was used for vessel preparation before drug-coated balloon angioplasty; adjunctive stenting was reserved for residual stenosis, recoil, or flow-limiting dissection. Overall survival, primary patency, and freedom from target-lesion reintervention were estimated using Kaplan-Meier analysis. Mean age was 73.2 ± 9.3 years; 34 patients (79.1%) had diabetes and 21 (48.8%) had chronic kidney disease. Mean lesion length was 25.5 ± 6.0 cm. Chronic total occlusions were present in 27 patients (62.8%), popliteal involvement in 18 (41.9%), and TASC C/D disease in 38 (88.4%). PACSS grade 3 and 4 calcification were present in 19 (44.2%) and 24 (55.8%) patients, respectively. Technical success was achieved in all cases, with final residual stenosis <30%. Bailout stenting was required in 9 patients (20.9%). At 24 months, Kaplan-Meier estimates were 93.0% for overall survival and 90.6% for both primary patency and freedom from target-lesion reintervention. In this exploratory CLTI cohort, IVL-assisted femoropopliteal revascularization was feasible despite severe calcification and complex anatomy, with selective stenting and encouraging midterm patency and freedom from reintervention.
Acute kidney injury (AKI) is common following endovascular procedures and has been independently associated with increased hospital length of stay, mortality, and, in patients with severe chronic kidney disease (CKD), accelerated progression to end-stage renal disease (ESRD) requiring dialysis. Prior studies have often focused on peripheral angiograms and infrarenal endovascular aortic repair (EVAR), with limited contemporary multicenter studies focused on the outcomes of renal function following thoracic endovascular aortic repair (TEVAR). We analyzed the SVS-VQI TEVAR registry including patients from 2013-2025. Patients were stratified based on incidence of AKI in the post-operative period, defined as an increase in serum creatinine of either >0.3 mg/dL or 50% from pre-operative baseline. Patients who were dialysis-dependent at the time of TEVAR were excluded from this study. Patient demographics and perioperative variables were compared between the two cohorts utilizing univariate analysis. The primary outcome of this study was 30-day mortality among patients undergoing TEVAR stratified by development of AKI. Secondary outcomes included hospital and ICU length of stay, incidence of aortic-related reinterventions, and new dialysis requirement on hospital discharge. A logistic regression was subsequently performed to develop a risk prediction model utilizing AKI as a binary endpoint, with 70% of the dataset used for training and 30% for testing. A total of 26,702 patients who underwent TEVAR were included, of which 3,347 developed postoperative AKI (13%). A higher proportion of patients with AKI were male (65.8% vs 62.2%, p<0.0001), had higher preoperative creatinine (1.46 mg/dL vs 0.99 mg/dL, p<0.0001), and were more frequently diabetic (17.8% vs 15.6%, p = 0.0011). TEVAR in patients who developed AKI was more frequently performed emergently (35.2% vs 14.7%) and for the indication of acute dissection (36.4% vs 25.7%, both p<0.0001). The development of postoperative AKI was associated with significantly higher 30-day mortality (21.3% vs 4.7%) and length of stay (18.3d vs. 3.6d, both p<0.0001). For patients presenting with acute dissection, AKI development was associated with more distal extent of dissection, decreased true lumen perfusion and postoperative branch patency of all visceral vessels (all p<0.0001). AKI following TEVAR is associated with substantially increased 30-day mortality, and is strongly associated with impaired baseline renal function, existing diabetes mellitus, urgent procedures, and aortic dissection.
This is a summary of the original research article "Aflibercept 8 mg versus Faricimab Treat‑and‑Extend for Diabetic Macular Edema or Neovascular Age‑Related Macular Degeneration: A Bayesian Fixed‑Effect Network Meta‑analysis of Clinical Trials." Diabetic macular edema (DME) and neovascular age-related macular degeneration (nAMD) are eye diseases that can be treated with anti-vascular endothelial growth factor (anti-VEGF) therapies. As these therapies are given by injections into the eye, reducing the number of injections could reduce the treatment burden on patients and healthcare providers. Aflibercept 8 mg and faricimab treat-and-extend (T&E) may enable longer dosing intervals compared with other available anti-VEGF therapies for patients with DME and nAMD; however, they have not been compared against each other directly in clinical trials. This study used a statistical method called a network meta-analysis (NMA) to compare aflibercept 8 mg and faricimab T&E by synthesizing data from clinical trials, enabling an indirect comparison in the absence of head-to-head studies. Outcomes included the mean number of injections, changes in vision [best-corrected visual acuity (BCVA)] and changes in macula thickness [central subfield thickness (CST)]. CST should reduce if the treatment is working. On the basis of indirect comparison of available clinical trial data, this exploratory study found that there were significantly fewer injections with aflibercept 8 mg treatment compared with faricimab T&E over 2 years, for both patients with DME and nAMD, and there were no significant differences between the two medications for BCVA or CST changes. NMAs are based on indirect comparisons and therefore have limitations, and clinical trials or real-world studies would be required to confirm these conclusions. Please refer to the original article for further details on the methods and limitations of this analysis.
To evaluate completeness of operative note documentation in a vascular surgery service and to assess whether introduction of standardised procedure-specific templates was associated with improved documentation in a repeat audit cycle. We conducted a single-centre two-cycle closed-loop audit within a UK vascular surgery department. In Cycle 1, 63 consecutive operative notes from May 2024 were retrospectively reviewed against predefined documentation standards derived from Royal College of Surgeons guidance. Following identification of recurrent omissions, standardised procedure-specific templates were collaboratively developed, disseminated, and introduced at a departmental governance meeting. In Cycle 2, 72 consecutive operative notes from March 2025 were reviewed using the same data collection framework. The primary process measures were documentation rates for four safety-critical fields: indication for surgery, estimated blood loss, distal pulse status, and postoperative plan. Between-cycle differences were compared using Fisher's exact test and expressed as odds ratios (ORs) with 95% confidence intervals (CIs). Baseline documentation was incomplete across all four variables. Following template introduction, statistically significant improvements were observed for indication for surgery (43.2% to 79.5%; OR 5.07, 95% CI 2.38-10.80; p < 0.0001) and distal pulse status (19.6% to 65.4%; OR 7.99, 95% CI 3.61-17.68; p < 0.0001). No statistically significant improvement was observed for estimated blood loss (16.3% to 19.2%; OR 1.28, 95% CI 0.52-3.12; p = 0.66) or postoperative plan (39.1% to 44.9%; OR 1.22, 95% CI 0.61-2.42; p = 0.60). Standardised procedure-specific templates were associated with substantial, statistically significant improvements in two documentation domains. The absence of equivalent improvement in blood loss and postoperative plan recording, confirmed by formal hypothesis testing, indicates that these variables require distinct intervention strategies beyond structured prompting alone. This closed-loop audit supports continued template refinement, targeted behavioural and systems-level interventions, and further re-audit.
While current guidelines recommend ankle-brachial index (ABI) or toe-brachial index (TBI) for all diabetic foot ulcer (DFU) patients due to poor diagnostic accuracy of physical examination, adherence remains unclear. This study aimed to evaluate the performance and timeliness of ABI/TBI testing among newly diagnosed DFU patients. We conducted a retrospective cohort study using Veterans Affairs (VA) data from 1/1/2019 to 12/31/2023. Veterans aged ≥65 years with a new DFU diagnosis were included. ABI/TBI within one year before or after the DFU diagnosis was recorded. Multivariable mixed-effects logistic regression with a facility random intercept evaluated factors associated with ABI/TBI and facility-level variation of vascular screening. Among 57,265 patients, 46.0% completed ABI/TBI. The median time from DFU diagnosis to ABI/TBI was 24 days (IQR 3-92). Patients with complicated DFU (osteomyelitis or gangrene) were more likely to undergo ABI/TBI (74.5% vs. 43.0% for uncomplicated DFU) and had shorter wait times (median 2 days vs. 32 days for uncomplicated DFU), suggesting ABI/TBI was often reserved for complicated DFU patients. There was notable facility-level variation for ABI/TBI (median odds ratio 2.40) after adjustment for patient and facility characteristics, suggesting that systemic barriers may influence vascular screening practices. Fewer than half of DFU patients received ABI/TBI, and testing was often delayed or reserved for advanced disease. System-level interventions to implement universal ABI/TBI screening for DFU patients are needed.
Atrial fibrillation (AF) care has shifted dramatically, with a focus on early rhythm control to reduce AF-related morbidity and mortality and improve quality of life. However, clinical trials for AF rely on historical definitions of treatment failure, including freedom from recurrence of ≥ 30 seconds of atrial fibrillation/flutter/tachycardia, which is a poor predictor of AF severity, or traditional clinical endpoints (i.e., stroke, heart failure, death) which have low incidence in contemporary AF populations. Therefore, a directly measurable and clinically meaningful measure for these clinical endpoints has the potential to accelerate clinical trials of rhythm control in AF while reducing overall trial overhead. The Cardiovascular Sciences Research Consortium hosted a Think Tank comprising scientists, clinicians, regulators, and industry representatives to develop a roadmap to establish AF burden as a valid surrogate clinical endpoint. This document reviews currently available data to support the use of AF burden as a surrogate endpoint, provides standards for measuring AF burden across measurement modalities and devices, and establishes a practical roadmap for a collaborative approach to validating the use of AF burden. Moving beyond historical definitions of AF treatment success and failure, AF burden has the potential to be a patient-centric endpoint that can leverage contemporary monitoring technologies while serving as an early signifier of AF-related risk.
Vitamin K deficiency impairs the activation of calcification inhibitors such as matrix Gla protein, promoting vascular calcification in CKD. Protein induced by vitamin K absence-II (PIVKA-II) is a filtration-independent marker of vitamin K status validated in hemodialysis, yet no data exist in peritoneal dialysis (PD). Sixty prevalent PD patients at a single tertiary center were prospectively followed for 1 year. Serum PIVKA-II, dephosphorylated uncarboxylated matrix Gla protein (dp-ucMGP), and bone morphogenetic protein-2 (BMP-2) were measured at baseline and 12 months. Carotid plaque was assessed by ultrasonography. Independent predictors of plaque were identified by multivariable logistic regression and ROC analysis. Carotid plaque was present in 36 patients (60%). Vitamin K deficiency (PIVKA-II >40 mAU/mL) was identified in 43.3% and was more prevalent in plaque-positive patients (55.5% vs 25.0%; p = 0.019). All three biomarkers were significantly elevated in the plaque group. Age (OR 1.26; 95% CI 1.07-1.42; p = 0.004) and PIVKA-II (OR 1.71; 95% CI 1.09-2.70; p = 0.022) independently predicted plaque. The area under the ROC curve was 0.766 (p = 0.001) with an optimal cutoff of 35.09 mAU/mL (sensitivity 86.1%, specificity 50.0%). Over 12 months, plaque prevalence rose to 70%; baseline BMP-2 was the sole predictor of new plaque development (p = 0.022). PIVKA-II-assessed vitamin K deficiency is common in PD and independently associated with carotid plaque. A threshold of 35 mAU/mL may be more sensitive than the conventional 40 mAU/mL cutoff, supporting PIVKA-II screening and targeted supplementation trials in PD.
Aortic intramural hematoma (IMH) has an unpredictable clinical course depending on the extent of disease. Management remains unclear for patients with type B IMH with concomitant type A IMH. We examine our experience with thoracic endovascular aortic repair (TEVAR) for this patient subset. The study design and research was approved by our Institutional Review Board and the need for informed consent was waived. This is a single-institution retrospective study of patients with type B IMH with an ulcer-like projection (ULP) in the descending thoracic aorta, as well as retrograde type A IMH, who underwent TEVAR between 2018-2024. IMH thickness and extent was examined on CTA imaging to assess for resolution and positive aortic remodeling after TEVAR. We identified 65 patients between 2018-2024 treated at our institution for IMH. Of those, 7 patients had a type B IMH with ulcer-like projection with concomitant retrograde arch extension of the IMH, treated with TEVAR. In our series, 5 patients had resolution of the retrograde type A IMH by 5 months, and as early as 3-5 weeks in 2 of those patients. The type B component of IMH had resolved in 5 patients by 10 months, and as early as 11-14 days in 2 patients. One of the 7 patients was lost to follow up. Early TEVAR for patients with type B IMH with ulcer-like projection with concomitant retrograde ascending aortic or arch IMH, is a management strategy that can promote favorable aortic remodeling, without the need for open ascending aortic repair.
To describe the clinical effectiveness and safety of dalbavancin (DAL) for the treatment of Vascular Graft and Endograft Infections (VGEI). A retrospective, single-center observational study was conducted at a tertiary-care university hospital in Rome from January 2020 to December 2024, including all consecutive patients diagnosed with VGEI who received at least one dose of DAL. Cases were identified through the hospital electronic medical record database. VGEIs were diagnosed using MAGIC criteria. Primary outcomes were clinical and radiological response at the end of treatment (EOT) and at six-month follow-up. Thirteen patients were included (median age: 76 years; 92% of males; median Charlson Comorbidity Index 5). Aortic vessels were involved in 61.5% of cases, peripheral vessel in 38.5%. Microbiological identification was achieved in 84.6% of cases, with Staphylococcus aureus (MSSA and MRSA) being the most frequent pathogen. Surgical explant was performed in 53.8% of patients, predominantly for peripheral VGEIs. DAL was used to facilitate early discharge (69.2%) or as suppressive antibiotic therapy (30.8%). No adverse events related to DAL were reported. Clinical success was achieved in 84.6% of patients at EOT and maintained in 61.5% at six-month follow-up. DAL appears to be an effective and well-tolerated option for the management of VGEI, particularly in frail patients or those not eligible for surgery, both to facilitate early discharge and as long-term SAT. Further prospective studies are needed to confirm these findings.
Target vessel (TV) catheterization during fenestrated-branched endovascular aortic aneurysm repair (FBEVAR) relies primarily on fluoroscopy. Fiber optic real-time shape (FORS) technology (Philips Medical Systems, Best, Netherlands) uses light refracted through optical fibers to generate real-time renderings of wires and catheters in three-dimensional (3D) space allowing their navigation without radiation. The LumiGuide is an enhanced longer version of the standard guidewire that is coupled with a 3D Hub connector to enhance visualization of commercially available catheters. This study aims to compare the outcomes and radiation exposure using the standard FORS enabled guidewire vs. the LumiGuide for FBEVAR. Data collected from 218 FBEVARs (129 standard FORS, 89 LumiGuide) included 931 TV catheterizatons (590 with standard FORS and 341 with LumiGuide). Technical success was defined as the successful catheterization of the TVs using only FORS. FORS and LumiGuide were compared in terms of technical success rates, procedure times, catheterization duration, fluoroscopy times, and cumulative dose-area products (DAP). Welch's t-test was used for continuous variables, while a z-test was applied for proportions. Patient characteristics did not demonstrate significant differences between groups. FORS technical success was 56.2% with standard FORS vs. 79.4% with LumiGuide (P<.001). Compared to standard FORS, the use of LumiGuide resulted in non-significant reduced navigation time per TV (6.4±7.4 vs 6.7 min±9.6; P=.6), DAP per TV (3.2±5.3 Gy·cm2 vs 3.36±9.3 Gy·cm2, P=.79), and significant reduction in procedure time (257 ± 91 minutes vs 298 ± 100 minutes; P = .002), fluoroscopy time (58±38 min vs 80±40; P=.01) and contrast dose (130±40 vs 150±50 mL; P=.05). Cumulative DAP remained similar between groups (59±38 Gy·cm2 for LumiGuide vs. 64±43 with standard FORS; P=.5). The introduction of LumiGuide and the 3D-Hub for FBEVAR improved FORS technical success and reduced procedure times compared to earlier FORS procedures. The ability to use different commercially available catheters with LumiGuide results in enhanced convenience and lower radiation exposure, thereby improving efficiency and safety.
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Coronary artery bypass surgery (CABG) is the most common technique in cardiac surgery. Distal anastomoses are currently almost exclusively hand-sewn, which limits widespread implementation of less invasive approaches. The aim of this trial is to investigate the safety and effectiveness of the Excimer Laser-Assisted Non-occlusive Anastomosis (ELANA) device to construct distal anastomoses in CABG. This study is a single-center, single-arm, prospective trial. Eligible patients were included from June 2023 to August 2024. The left internal thoracic artery (LITA) to left anterior descending (LAD) anastomosis was constructed using the ELANA anastomotic system, with additional hand-sewn anastomoses if required. The primary outcome was device-related Major Adverse Cardiac Events (MACE; consisting of cardiac death, and myocardial infarction (MI) or repeat revascularization of the LAD territory) at 1 year. Secondary outcomes included 6-month LITA patency assessed by coronary angiography defined by FitzGibbon (FG) criteria and 1-year overall MACE (composite death, MI and repeat revascularization of all coronary artery territories). 71 Patients (89% male, aged 71.0 ± 6.5 years) were included. 1-Year device-related MACE was 2.9%, consisting of cardiac death and MI due to LITA failure, while overall MACE was 8.7%. Six-month LITA patency was 92.5%: FG A 40.6%, B 51.6%, O 7.8%. Intravascular ultrasound was performed in six patients with FG B, which revealed no significant stenosis. This trial demonstrates the safety and effectiveness of the ELANA device, but long-term follow-up is needed to confirm this. Trials are needed to investigate whether this device facilitates less invasive approaches in CABG.
Bronchopulmonary dysplasia is a frequent complication of preterm birth and is often associated with the development of pulmonary hypertension (BPD-PH). BPD-PH is a multifactorial disease with variable hemodynamic phenotypes typically characterized by underdeveloped pulmonary vascular networks with altered microvascular function, carrying significant morbidity and mortality in infancy. Advances in neonatal care have improved the survival of preterm infants. Amongst survivors, there is a trend toward resolution of BPD-PH with adequate respiratory support and somatic growth, highlighting the importance of early recognition and intervention to optimize vascular growth potential. However, as this population ages the idea of "resolution" has been brought into question. There is increasing awareness of subclinical or recurrent pulmonary hypertension as survivors of prematurity from childhood through early adulthood suggesting that the vasculature remains at risk throughout life. The natural history of pulmonary vasculature is one of development, growth and aging. Each window presents unique opportunities and potential insults that impact overall BPD-PHseverity and progression. Here we review care of the BPD-PH patient across the lifespan highlighting windows of opportunity to reduce lifetime exposure to pulmonary hypertension.
Neonatal stroke is a rare but clinically significant neurological disorder associated with substantial morbidity and potentially severe long-term sequelae. Despite advances in diagnostic techniques, uncertainties remain regarding diagnosis, treatment, and follow-up care. The aim of this S2k guideline is to provide evidence- and consensus-based recommendations for the standardized management of neonates with arterial ischemic stroke, hemorrhagic stroke, and cerebral sinovenous thrombosis (CSVT). The guideline was developed through a structured S2k consensus process involving multidisciplinary professional societies and experts. Recommendations were based on a systematic review of the available literature and a formal consensus procedure to establish diagnostic and therapeutic guidance. The guideline defines neonatal stroke as the acute onset of neurological symptoms within the first 28 days of life associated with a cerebrovascular event confirmed by magnetic resonance imaging (MRI). Given the frequently nonspecific clinical presentation, particularly seizures, apnea, and altered consciousness, prompt diagnostic evaluation is recommended. Initial neuroimaging should consist of transfontanellar cranial ultrasonography including Doppler assessment, followed by MRI with diffusion-weighted imaging and vascular imaging, which represents the diagnostic gold standard. Computed tomography is not recommended because of radiation exposure and limited diagnostic sensitivity. Neonates with suspected stroke or seizures should undergo continuous neurophysiological monitoring using bilateral amplitude-integrated electroencephalography (aEEG). Routine screening for inherited thrombophilia is not recommended in cases of arterial ischemic stroke. Supportive management aimed at maintaining normoxia, normocapnia, normothermia, and stable glucose homeostasis constitutes the cornerstone of treatment. In neonates with CSVT, acute anticoagulation therapy and, when appropriate, extended anticoagulation are recommended in the absence of contraindications. Routine antithrombotic therapy following arterial ischemic stroke is not recommended because of the low recurrence risk. This S2k guideline provides comprehensive recommendations for the diagnosis, treatment, and long-term management of neonatal stroke and CSVT. Early identification of affected infants, appropriate use of advanced neuroimaging, and structured interdisciplinary follow-up are essential to minimize neurological sequelae and improve long-term neurodevelopmental outcomes. Der neonatale Schlaganfall stellt eine seltene, aber klinisch bedeutsame neurologische Erkrankung mit hoher Morbidität und potenziell schwerwiegenden Langzeitfolgen dar. Trotz zunehmender diagnostischer Möglichkeiten bestehen Unsicherheiten hinsichtlich Diagnostik, Therapie und Nachsorge. Ziel dieser S2k-Leitlinie ist die evidenz- und konsensbasierte Standardisierung der Versorgung von Neugeborenen mit arteriell ischämischem Schlaganfall, hämorrhagischem Schlaganfall und cerebraler Sinusvenenthrombose (CSVT).Die Leitlinie wurde im Rahmen eines strukturierten S2k-Konsensusverfahrens unter Beteiligung multidisziplinärer Fachgesellschaften und Experten erstellt. Grundlage bildeten die systematische Auswertung der verfügbaren Literatur sowie ein formalisierter Konsensprozess zur Erarbeitung diagnostischer und therapeutischer Empfehlungen.Die Leitlinie definiert den neonatalen Schlaganfall als akut auftretende neurologische Symptomatik innerhalb der ersten 28 Lebenstage mit MRT-gesichertem zerebrovaskulärem Ereignis. Aufgrund der häufig unspezifischen klinischen Präsentation, insbesondere durch Krampfanfälle, Apnoen oder Vigilanzstörungen, wird eine rasche Diagnostik empfohlen. Als primäre Bildgebung soll eine transfontanelläre Sonografie inklusive Doppleruntersuchung erfolgen, gefolgt von einer Magnetresonanztomografie mit Diffusions- und Gefäßdarstellung als diagnostischem Goldstandard. Eine Computertomografie wird aufgrund der Strahlenbelastung und geringen Sensitivität nicht empfohlen. Neugeborene mit Verdacht auf Schlaganfall oder Krampfanfälle sollen kontinuierlich mittels bihemisphärischem amplitudenintegriertem EEG überwacht werden. Ein routinemäßiges Screening auf thrombophile Gerinnungsstörungen wird bei arteriell ischämischem Schlaganfall nicht empfohlen. Therapeutisch stehen supportive Maßnahmen zur Sicherstellung von Normoxie, Normokapnie, Normothermie und normoglykämischen Stoffwechselbedingungen im Vordergrund. Für die neonatale CSVT wird bei fehlenden Kontraindikationen eine akute und gegebenenfalls längerfristige Antikoagulation empfohlen. Eine routinemäßige antithrombotische Therapie nach arteriell ischämischem Schlaganfall wird aufgrund der niedrigen Rezidivrate nicht empfohlen.Die S2k-Leitlinie bietet erstmals umfassende Empfehlungen zur Diagnostik, Therapie und Langzeitbetreuung von Neugeborenen mit Schlaganfall und CSVT. Die frühzeitige Identifikation betroffener Kinder, der gezielte Einsatz moderner Bildgebung sowie eine strukturierte interdisziplinäre Nachsorge sind entscheidend, um neurologische Folgeschäden zu minimieren und die langfristige Entwicklung zu verbessern.
Atherosclerotic plaque rupture is a major cause of cerebrovascular events, yet the molecular determinants underlying vulnerability-related plaque morphology, including fibrous-cap thickness, remain incompletely defined. Using histomorphology-guided spatial proteomics, here we delineate molecular programs associated with plaque cap phenotype across discrete plaque subregions. In 112 carotid endarterectomy specimens, differences between thin-cap and thick-cap plaques were predominantly localized to the necrotic core and fibrous cap. These differences were enriched for processes related to inflammation, lipid handling, extracellular matrix remodeling and ossification/calcification, and supported the presence of proteome-based plaque subtypes. PCSK9 was among the proteins most strongly associated with thin-cap plaques. Consistently, an in vitro model of necrotic core-like oxidative and inflammatory stress increased PCSK9 secretion in primary vascular smooth muscle cells. Together, these findings localize molecular programs associated with cap phenotype to plaque compartments and provide a framework for spatially informed biomarker discovery in advanced carotid atherosclerosis.
UNICORN (undermining coronary obstruction with radiofrequency "needle") has been adopted by some operators to prevent coronary obstruction during transcatheter aortic valve replacement (TAVR). More clinical data are needed to evaluate UNICORN outcomes. The aim of this study is to describe preliminary outcomes of UNICORN during TAVR. Nine sites contributed consecutive patients undergoing UNICORN TAVR from March 2024 to May 2025. Primary success was UNICORN TAVR without composite periprocedural coronary obstruction, reintervention, or death. Primary safety endpoints were intraprocedural hypotension plus overall 30-day safety, which included 30-day death, stroke, coronary obstruction requiring reintervention, stage 3 or 4 acute kidney injury, life-threatening bleeding, major vascular complication, and valve-related reintervention. Two UNICORN techniques, intraleaflet deployment and full-leaflet tearing, were used. Fifty-three patients (8 native aortic valves, 30 surgical valves, and 15 transcatheter valves) were included. Left-sided and right-sided UNICORN procedures were performed in 30 (57%) and 19 (36%), respectively. UNICORN was bilateral in 4 (8%). Eleven (21%) underwent contralateral BASILICA (bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction), and 3 (6%) received contralateral snorkel-stent protection. Forty patients (76%) underwent intraleaflet deployment, and 13 (24%) underwent full-leaflet tearing. Primary success occurred in 51 patients (96%). Two (4%) experienced coronary obstruction and required rescue percutaneous coronary intervention. Overall 30-day safety was observed in 46 patients (87%), with strokes in 3 (6%), life-threatening bleeding in 2 (4%), and major vascular complications in 2 (4%). Intraprocedural hypotension occurred in 12 (23%). There were no deaths, valve-related reinterventions, or stage 3 to 4 acute kidney injury at 30 days. UNICORN during TAVR was successful in preventing coronary obstruction. Intraprocedural hypotension requiring vasopressor support was frequent. UNICORN should be considered in cases in which lower risk options are unlikely to be successful.
Adequate renal perfusion is critical for maintaining kidney function, and its impairment contributes significantly to acute kidney injury (AKI) and related cardiovascular complications. Dopamine (DA) is clinically employed to improve renal perfusion, but its efficacy remains controversial due to paradoxical vasoconstriction at higher doses. This study systematically evaluates DA-induced vasomotor responses in human intrarenal arteries and elucidates the underlying molecular mechanisms. Human intrarenal artery segments, including interlobar (IA, ∼1 mm), arcuate (AA, ∼500 μm), and interlobular arteries (ILA, ∼200 μm), were analyzed using ex vivo tension assays, pharmacological interventions, RNA sequencing, and siRNA silencing to delineate segment-specific DA responses and molecular basis. DA (1 nM-10 µM) consistently induces vasodilation across all human intrarenal arteries, challenging the conventional notion that "renal-dose DA" causes vasoconstriction. IA and AA segments exhibit more pronounced vasodilation than ILA, mediated by dopamine receptor D1 (DRD1)-dependent protein kinase A (PKA)-BK channel signaling. Specifically, higher expression and activity of the BK channel regulatory β-subunit (KCNMB1) in IA and AA accounted for their increased sensitivity to DA. Transcriptomic profiling further identified distinct molecular heterogeneity among IA, AA and ILA segments, reflecting their divergent physiological roles. In contrast, rodent intrarenal arteries respond to DA with vasoconstriction rather than dilation, due to the lack of the BK channel pore-forming α-subunit (KCNMA1), which shifts the balance toward α-adrenergic vasoconstriction. Our study overturns the traditional paradigm of "renal-dose DA"-induced vasoconstriction, supports DRD1 agonism as a promising strategy for renal hypoperfusion, and emphasizes critical species differences that necessitate human-based validation in translational vascular research.
The impact of mercury (Hg) on the estimated glomerular filtration rate (eGFR) remains inconsistent across epidemiological studies, often due to low exposure levels or the presence of dietary factors such as selenium (Se). This study evaluates the independent association between blood Hg and eGFR in a population with high dietary fish intake. A cross-sectional study was conducted on 373 healthcare workers in Madrid, Spain. Blood levels of Hg were measured by cold vapour atomic absorption spectrometry and Cd, Pb and Se by electrothermal atomization atomic absorption spectrometry. eGFR was calculated using the CKD-EPI formula. Participants were categorized by the median blood Hg level (8 µg/L), a threshold previously linked to cardiovascular risk. Participants had a mean age of 47.3 ± 10.9 years, and a mean estimated glomerular filtration rate (eGFR) of 78.9 ± 11.8 mL/min/1.73 m²; 16.1% were male. Median blood mercury concentration was 8.0 µg/L (IQR: 5.2-11.6); median cadmium and lead levels were 0.29 µg/L (IQR: 0.18-0.50) and 1.7 µg/dL (IQR: 1.0-2.8), respectively, while mean selenium was 79.4 ± 11.7 µg/L. In linear regression analyses, blood mercury levels > 8 µg/L were associated with lower eGFR in the unadjusted model (β = -3.78; 95% CI: -6.17 to -1.39; p = 0.002) and after adjustment for age, sex, and vascular risk factors (β = -3.08; 95% CI: -5.45 to -0.72; p = 0.011). This association remained significant after further adjustment for co-exposure to cadmium, lead and selenium (β = -2.62; 95% CI: -5.02 to -0.21; p = 0.033). In a population of healthcare workers with high fish consumption, blood mercury levels above 8 µg/L are associated with a modest reduction in eGFR. These findings suggest that Hg may exert a subtle influence on renal filtration independent of other common nephrotoxic metals and dietary elements like selenium.