M.P. Girish

Percutaneous Revascularization of Sole Arch Artery for Severe Cerebral Ischemia Resulting from Takayasu Arteritis

PURPOSE Takayasu arteritis (TA) is a rare form of inflammatory arteriopathy affecting the aorta and its major branches. Obstructive lesions of all arch vessels may lead to disabling neurologic symptoms. There is limited experience with endovascular revascularization in this situation. The present report describes immediate and follow-up results with stent-supported angioplasty of severely stenosed single patent arch arteries. MATERIALS AND METHODS Angioplasty and stent placement were performed in 10 consecutive patients with TA (age, 11-42 years; mean, 28.3 y +/- 4.1) with cerebrovascular symptoms caused by severe stenotic lesions of supraaortic (ie, carotid, vertebral, and brachiocephalic) arteries. RESULTS Angioplasty was attempted in 12 stenotic lesions: carotid (n = 8), vertebral (n = 2), and brachiocephalic (n = 2). Eight lesions were discrete and four were diffuse. Balloon angioplasty and stent implantation were performed successfully in all patients. The luminal diameter increased from 0.84 mm +/- 0.6 to 5.6 mm +/- 0.7 (P < .001), and the diameter of stenosis was reduced from 81.1% +/- 6.8% to 1.7% +/- 3.3% (P < .001). No immediate procedure-related complication or neurologic deficits occurred. The symptoms improved in all patients. On follow-up (mean, 25 months +/- 7; range, 3-49 months), eight patients were asymptomatic and two patients with diffuse stenosis had recurrence of neurologic symptoms. These patients had in-stent restenosis of the carotid artery, which was successfully treated with cutting balloon angioplasty. CONCLUSION Stent-supported angioplasty of a sole supraaortic artery in TA is safe and effective and provides good symptomatic relief in patients with multiple stenoocclusive lesions of arch arteries.

Biochemical and genetic role of apelin in essential hypertension and acute coronary syndrome

BACKGROUND Apelin-APJ pathway has emerged as a potent regulator of blood pressure (BP) and blood flow in vasculature and heart. Variants in apelin gene may affect the vascular tone in peripheral circulation or heart, thereby predisposing to cardiovascular diseases. The aim of our study was to investigate the association of two apelin gene polymorphisms rs3761581 and rs2235312, and apelin levels in patients with essential hypertension (EH) and acute coronary syndrome (ACS). METHODS The study comprised of three groups namely, (1) 118 healthy control subjects, (2) 92 EH patients, and (3) 60 ACS patients. DNA was extracted from peripheral blood leukocytes and genotyping was performed by SNaPshot method. Plasma apelin 13 levels were estimated using ELISA. RESULTS EH and ACS patients had a significantly lower level of apelin 13, regardless of gender (p=0.003, p=0.017, respectively). Interestingly, the female EH and ACS patients had lower levels of apelin 13 than their male counterparts. The G allele of rs3761581 was more apparent in patients especially in ACS than the controls. CONCLUSION Reduced apelin levels may enhance vasoconstriction to influence high BP and hearts workload in EH and ACS. Genetic involvement of apelin needs to be established in well-defined larger sample size.

Endovascular revascularization of bald aortic arch for severe cerebral ischemia

Takayasu arteritis is a rare form of chronic, inflammatory arteriopathy affecting the aorta and its major branches. Obstructive lesions of all arch vessels lead to ischemic brain symptoms. There is very limited experience of endovascular revascularization in this situation. We report case of a female patient with potentially life threatening cerebral ischemic symptoms due to extra‐cranial occlusion of all arch arteries. Stent supported angioplasty of brachiocephalic, right common carotid and right subclavian artery was successfully performed. This improved her cerebral blood flow and relieved her severe, disabling neurologic symptoms.

Entrapped coronary angioplasty stent balloon due to nondeflation: Percutaneous retrieval by a simple technique

Complication due to hardware failure may happen even in the most straightforward interventional procedures. We report an unusual complication of nondeflation of coronary stent balloon entrapped within the coronary tree. The nondeflated balloon was retrieved percutaneously by a simple technique.

β-T594M epithelial sodium channel gene polymorphism and essential hypertension in individuals of Indo-Aryan ancestry in Northern India

BACKGROUND The T594M variant of the β-subunit of the sodium epithelial channel (ENaC) gene may contribute to hypertension in individuals of Indo-Aryan origin. METHODS Present study was performed to assess the role of the ENaC gene variant as an independent risk factor for hypertension in subjects of Indo-Aryan ancestry. A total of 150 patients of recently detected essential hypertension and 150 matched controls were genotyped for the T594M polymorphism of the ENaC gene by PCR-RFLP method. RESULTS β-T594M mutation was found to be non-polymorphic. There was major genotype call in both the groups i.e. cases and controls. Other phenotypic parameters like age, sex and body mass index were also similar among hypertensive patients and controls (P > 0.05). Hypertensive patients had significantly higher total cholesterol and triglycerides compared with controls (P < 0.0001). CONCLUSION These results do not suggest an important role for the T594M variant of the ENaC gene contributing to either the development or severity of hypertension in subjects of Indo-Aryan ancestry.

Persistent Left Superior Vena Cava Draining Into an Unroofed Coronary Sinus in Tricuspid Atresia: An Uncommon Anomaly

This report describes the preoperative diagnosis of a 6-month-old child with tricuspid atresia related to an unroofed coronary sinus. The anomaly usually is diagnosed after the Fontan operation due to persistent arterial desaturation. Preoperative recognition of this association is important. All cases of tricuspid atresia should be screened for associated persistent left superior vena cava draining into an unroofed coronary sinus.

Percutaneous coronary intervention of all three coronary arteries originating from single coronary artery arising from the right sinus.

Anomalous origin of left coronary artery from right sinus of Valsalva (RSV) is extremely rare when not associated with other cardiac anomalies. We describe a case of single coronary artery arising from the RSV in a 75-year-old male patient with coronary heart disease. Angiography revealed significant atherosclerotic stenosis in all the three coronary arteries. This report highlights the feasibility and safety of multivessel percutaneous coronary intervention (PCI) in this rare anomaly and discusses the important technical considerations to be kept in mind while attempting such a case. This is the first report in the literature describing PCI in all the vessels of a single coronary trunk arising from RSV.

Restoration of vision by endovascular revascularization in Takayasu arteritis: A case series

Takayasu arteritis (TA) is a rare, inflammatory vasculitis affecting aorta and its branches. Stenotic occlusive lesions of multiple arch arteries can cause severe cerebral ischemia leading to impaired vision. We present three consecutive young patients of TA with severe diminution of vision on upright posture, where we attempted restoration of sight by improving cerebral blood flow by percutaneous endovascular revascularization. All three patients could be successfully revascularized with substantial improvement in vision. There was no complication. On follow up, one patient developed recurrence of visual symptoms due to restenosis, which was successfully treated by cutting balloon angioplasty. The objective of this case series is to highlight the role of endovascular techniques in reversing visual loss in such situations. <Learning objective: Takayasu arteritis (TA) is an inflammatory vasculitis that can affect arch arteries leading to near complete obliteration and often disabling symptoms such as loss of vision. This case series (3 cases) shows that stent-supported angioplasty is a minimally invasive technique which is safe and effective in restoring impaired vision caused by severe cerebral hypoperfusion in TA.>.

Endovascular Management of Acute Aortic Dissection in Takayasu Arteritis

Takayasu arteritis (TA) is an uncommon, chronic vasculitis affecting the aorta and its major branches, causing stenosis, occlusion, and aneurysm formation. Aortic dissection is a rare, catastrophic complication of TA [(1)][1], and dissection as the initial presentation is still rarer [(2)][2]. We

Amyloidotic pseudo-spectacles

A 60-year-old man presented with progressive exertional dyspnoea and swelling in the bilateral lower limb. His relatives noted discolouration around the eyes over the last 6 months. He had a history of easy bruisability and noticed spontaneous ecchymotic patches for a couple of years with no other significant bleeding manifestations. On physical examination, he was noted to have bilateral periorbital ecchymosis with normal sclera (figure 1), raised jugular venous pressure with prominent a waves and x …