Philanthropy New York

Introduction: In addition to socioeconomic factors, residents in rural areas face unique challenges that contribute to poor diet quality. We assessed Alternative Healthy Eating Index (aHEI) scores among residents of a rural county in New York with documented poor health outcomes. Methods: In 2021, we performed a cross-sectional survey of residents in Sullivan County, NY. This survey included questions on sociodemographics and a validated food frequency questionnaire (FFQ). We used multivariable linear regression to identify factors associated with lower aHEI scores, including: age, sex, race/ethnicity, household type, income, education, unemployment, disability, distance to grocery store, frequency of eating from canned foods and plastic-wrapped foods consumption (two attributes not captured in the FFQ), use of food support programs, food insecurity, housing insecurity, and difficulty meeting essential household and medical expenses. Results. Of 1,356 respondents analyzed, aHEI scores followed a normal distribution (mean: 56.5, standard deviation: 12.0). Adjusting for other factors, respondents that did not enter high school had an average aHEI that was 9.7 points lower compared to those that had completed college. Respondents reporting disability or food insecurity had lower aHEI compared to those that did not (respectively 3.6 and 3.2 points lower). Respondents consuming canned foods most of the time had a 6.0 lower aHEI than those that never ate canned foods. Discussion. We identified potentially modifiable risk factors for poor diet quality among rural residents. Efforts to reduce food insecurity along with better access to healthy foods in order to reduce canned food intake may be needed to address these rural health disparities. Disclosure C.Quintero arias: None. D.C.Lee: None. M.Rony: None. E.Jensen: None. A.Prabu: None. N.N.Wise: None. K.Doran: None. R.Anthopolos: None. B.Elbel: None. L.Thorpe: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (R01DK124400)

To report the use of parallel grafts to extend the proximal landing zone for stent-graft repair of aortic transection involving an aberrant right subclavian artery (ARSA). A 28-year-old patient was referred for treatment of traumatic aortic transection with contained rupture at the level of an ARSA. Immediate thoracic endovascular aortic repair (TEVAR) was planned because of hemodynamic instability. To achieve rapid sealing and maintain perfusion to both subclavian arteries, a chimney stent to the left subclavian artery (LSA) and a periscope stent-graft to the ARSA were deployed successfully. After surgical repair of all fractures, the patient was discharged 1 month after the initial injury in good condition. Imaging follow-up at 10 months showed a stable repair, patent parallel grafts, and no complications. TEVAR with chimney and periscope grafts proved to be a safe and quick treatment for a patient requiring ARSA repair in acute aortic transection. This technique maintained blood flow to the ARSA and LSA in a totally endovascular approach, which could be very valuable in transection cases where bypass surgery to supra-aortic branches is compromised or deemed challenging due to thoracic wall and/or neck trauma. Parallel grafting can be a valuable tool to address any acute aortic pathology as it can be performed with off-the-shelf devices.

See related article, p 702. In this issue of Stroke , Hirt1 reports that substantial progression of carotid stenosis predicted ipsilateral stroke or transient ischemic attack among patients randomized to medical therapy in the Asymptomatic Carotid Surgery Trial (ACST).2 This might be regarded as another justification to perform carotid endarterectomy (CEA) or stenting (CAS) in some patients with asymptomatic carotid stenosis (ACS), and Hirt’s article may help in the selection for invasive treatment of those ACS patients at highest risk of having a stroke. However, the proportion of patients with progression by ≥2 grades (which carried a high enough risk to identify patients who might benefit from invasive intervention) was small. Among the 1469 patients in the study, there were events in only 50 (3.4%), among the 117 (8%) of patients with progression by ≥2 grades of stenosis. It must also be understood that the ACST trial was conducted before the widespread implementation of intensive medical therapy that has diminished the stroke risk picture markedly. The current situation in the United States is deplorable: as many as 95% of CEA and CAS procedures are being performed in patients with asymptomatic stenoses,3 and most of these patients are more likely to be harmed than helped by these interventions. This is being justified on the basis of historical stroke risks in the ACST2 and the Asymptomatic Carotid Surgery Trial.4 These risks …