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In this article, we will review the technical implementation, preclinical research, clinical applications, and future directions of HRMRI for the evaluation of ICAD at 3.0 T and 7.0 T.Intracranial atherosclerotic disease (ICAD) is one of the most common causes of ischemic stroke worldwide. PHI-101 Along with high recurrent stroke risk from ICAD, its association with cognitive decline and dementia leads to a substantial decrease in quality of life and a high economic burden. Atherosclerotic lesions can range from slight wall thickening with plaques that are angiographically occult to severely stenotic lesions. Recent advances in intracranial high resolution vessel wall MR (VW-MR) imaging have enabled imaging beyond the lumen to characterize the vessel wall and its pathology. This technique has opened new avenues of research for identifying vulnerable plaque in the setting of acute ischemic stroke as well as assessing ICAD burden and its associations with its sequela, such as dementia. We now understand more about the intracranial arterial wall, its ability to remodel with disease and how we can use VW-MR to identify angiographically occult lesions and assess medical treatment responses, for example, to statin therapy. Our growing understanding of ICAD with intracranial VW-MR imaging can profoundly impact diagnosis, therapy, and prognosis for ischemic stroke with the possibility of lesion-based risk models to tailor and personalize treatment. In this review, we discuss the advantages of intracranial VW-MR imaging for ICAD, the potential of bioimaging markers to identify vulnerable intracranial plaque, and future directions of artificial intelligence and its utility for lesion scoring and assessment.Not only the degree of luminal narrowing but also the plaque morphology and composition play an important role in risk stratification of carotid atherosclerotic lesions. During the last few years, carotid contrast-enhanced ultrasound (CEUS) has emerged as a valuable imaging tool to assess such vulnerable carotid plaques. This review article discussed the use of CEUS for the detection of carotid plaque irregularities and ulcerations as well as the quantification of intraplaque neovascularization and its correlation with histology and inflammatory biomarkers. Apart from evaluating for markers of vulnerable carotid plaques, CEUS enhancement is directly associated with past cerebrovascular events. More importantly, preliminary evidence has shown that CEUS could be used to predict future cerebrovascular and cardiovascular events. Despite the progress in CEUS imaging for carotid atherosclerotic disease, past studies still suffer from the retrospective nature, small sample size, and a lack of matched, well controlled prospective studies. In the future, large multi-center prospective studies addressing the relationship between CEUS findings and patient clinical outcomes in carotid atherosclerotic disease are warranted.Ultrasound methods are useful in stroke prevention in several ways. Measurement of carotid plaque burden, as either total plaque area (TPA) or total plaque volume (TPV) are strong predictors of cardiovascular risk much stronger than intima-media thickness, which does not represent true atherosclerosis, but a biologically and genetically distinct phenotype. Measurement of plaque burden is also useful for the study of genetics, and of new risk factors such as toxic products of the intestinal microbiome. Carotid plaque burden is highly correlated with and as predictive of risk as coronary calcium scores, but is less costly and does not require radiation. Furthermore, because carotid plaques change in time over a period of months, they can be used for a new approach to vascular prevention "Treating arteries instead of treating risk factors". In high-risk patients with asymptomatic carotid stenosis (ACS), this approach, implemented in 2003 in our clinics, was associated with a >80% reduction of stroke and myocardial infarction over 2 years. "Treating arteries without measuring plaque would be like treating hypertension without measuring blood pressure". Ultrasound methods can also be used to assess plaque vulnerability, by detecting echolucency, ulceration and plaque inhomogeneity on assessment of plaque texture. Transcranial Doppler (TCD) embolus detection is useful for risk stratification in patients with ACS; patients with two or more microemboli in an hour of monitoring have a 1-year risk of 15.6%, vs. 1% without microemboli, so this very clearly distinguishes which patients with ACS could benefit from intervention. TCD saline studies are more sensitive than trans-esophageal echocardiography for detection of patent foramen ovale, and more predictive of recurrent stroke. These methods should be more widely used, to reduce the increasing burden of stroke in our aging populations.

Vascular age (VA) has recently emerged for CVD risk assessment and can either be computed using conventional risk factors (CRF) or by using carotid intima-media thickness (cIMT) derived from carotid ultrasound (CUS). This study investigates a novel method of integrating both CRF and cIMT for estimating VA [so-called integrated VA (IVA)]. Further, the study analyzes and compares CVD/stroke risk using the Framingham Risk Score (FRS)-based risk calculator when adapting IVA against VA.

The system follows a four-step process (I) VA using cIMT based using linear-regression (LR) model and its coefficients; (II) VA prediction using ten CRF using a multivariate linear regression (MLR)-based model with gender adjustment; (III) coefficients from the LR-based model and MLR-based model are combined using a linear model to predict the final IVA; (IV) the final step consists of FRS-based risk stratification with IVA as inputs and benchmarked against FRS using conventional method of CA. Area-under-the-curve (AUC) is computed using IVA and benchmarked against CA while taking the response variable as a standardized combination of cIMT and glycated hemoglobin.

The study recruited 648 patients, 202 were Japanese, 314 were Asian Indian, and 132 were Caucasians. Both left and right common carotid arteries (CCA) of all the population were scanned, thus a total of 1,287 ultrasound scans. The 10-year FRS using IVA reported higher AUC (AUC =0.78) compared with 10-year FRS using CA (AUC =0.66) by ~18%.

IVA is an efficient biomarker for risk stratifications for patients in routine practice.

IVA is an efficient biomarker for risk stratifications for patients in routine practice.

Statistically derived cardiovascular risk calculators (CVRC) that use conventional risk factors, generally underestimate or overestimate the risk of cardiovascular disease (CVD) or stroke events primarily due to lack of integration of plaque burden. This study investigates the role of machine learning (ML)-based CVD/stroke risk calculators (CVRC

) and compares against statistically derived CVRC (CVRC

) based on (I) conventional factors or (II) combined conventional with plaque burden (integrated factors).

The proposed study is divided into 3 parts (I) statistical calculator initially, the 10-year CVD/stroke risk was computed using 13 types of CVRC

(without and with plaque burden) and binary risk stratification of the patients was performed using the predefined thresholds and risk classes; (II) ML calculator using the same risk factors (without and with plaque burden), as adopted in 13 different CVRC

, the patients were again risk-stratified using CVRC

based on support vector machine (SVM) and finalgher compared all the other CVRC



ML-based CVD/stroke risk calculator provided a higher predictive ability of 10-year CVD/stroke compared to the 13 different types of statistically derived risk calculators including integrated model AECRS 2.0.

ML-based CVD/stroke risk calculator provided a higher predictive ability of 10-year CVD/stroke compared to the 13 different types of statistically derived risk calculators including integrated model AECRS 2.0.The recently presented ISCHEMIA trial found that, among patients with stable coronary artery disease (CAD) and proven moderate/severe ischemia, an invasive strategy failed to show a significant reduction in cardiovascular events compared to medical therapy alone. We aimed to assess the impact of ISCHEMIA on the daily practice of a public university hospital. We performed a retrospective analysis of the last 1,000 consecutive percutaneous coronary interventions (PCIs) performed in our center and applied the ISCHEMIA exclusion criteria to this population in order to estimate the proportion of these patients that would have been excluded from the trial. Interestingly, only 91 patients (9.1%) did not have any ISCHEMIA exclusion criteria, notably due to the high proportion of acute coronary syndrome (ACS). However, in a sub-analysis based exclusively on patients with stable CAD, 71.6% of the patients undergoing PCI would have been excluded from ISCHEMIA due to the presence of at least one exclusion criteria. In conclusion, in this retrospective analysis of 1,000 PCIs performed in a public university hospital, the majority of PCIs were performed in patients that would have had at least one exclusion criterion from ISCHEMIA. These results suggest that the impact of ISCHEMIA on the real-world practice of a public university hospital might be limited.Cardiogenic shock is a severe disease caused by primary failure of cardiac function. Myocardial infarction is the most common cause of cardiogenic shock. It is common in adults but rare in children. An anomalous left coronary artery originating from the right sinus of Valsalva with an inter-arterial course between the pulmonary trunk and aortic root is a rare isolated congenital anomaly, with a high risk of sudden cardiac death, particularly in the context of exercise. Coronary computed tomography angiography (CCTA) allows non-invasive evaluation of congenital coronary anomalies in adults and children, including the location of the anomalous origin, details of the intramural segment, and the angle between the ostium and proximal segment. However, there are few data describing the role of cardiac magnetic resonance (CMR) children because of long scanning time and several contraindications. This case report describes an 8-year-old male child with cardiogenic shock caused by acute myocardial infarction. CCTA revealed a left coronary artery arising from the right sinus of Valsalva with inter-arterial course, and a moderately narrowed mid-portion of left main coronary artery, while CMR indicated myocardial infarction which located in left ventricular anterior, septal and lateral wall, together with intramyocardial hemorrhage (IMH) and microvascular obstruction (MVO). Combined application of CCTA and CMR could show coronary artery anomalies, myocardial viability, tissue characteristics, and would play an important role in the diagnosis and assessment.The current pandemic of novel coronavirus disease 2019 (COVID-19) has posed a great threat to people's health worldwide, with specific implications on patients with underlying heart diseases. During this challenging period, nearly all major societies have recommended for conservative approach, even for patients with relatively stable acute cardiovascular diseases. Selection of specific antiplatelet therapy in an uncomplicated post percutaneous coronary intervention (PCI) patient can, at times, be crucial issue in such strained circumstances. We report a case of 64-year-old male, who was taken for urgent coronary angiogram (CAG) in view of non ST elevation acute coronary syndrome. Successful PCI with implantation of drug eluting stent was done for right coronary artery (RCA) and left anterior descending (LAD) artery lesions. On day 5th post-PCI, he developed acute inferior wall STEMI due to subacute stent thrombosis (ST), and despite all efforts, patient could not be saved as he didn't receive timely intervention.