The Cardiac and Vascular Institute

Minimally invasive image-guided tumor ablation techniques have been established as safe, effective methods to treat a variety of unresectable soft tissue tumors. Standard thermal ablation methods include radiofrequency ablation, microwave ablation, and cryoablation. However, newer non-thermal and/or non-invasive ablation techniques are now available as alternative options to treat soft tissue tumors, particularly those that are near critical structures or otherwise susceptible to thermal energy sink effects. The 4 types of emerging ablation techniques discussed in this review are as follows: irreversible electroporation, pulsed electric field, high-intensity focused ultrasound, and histotripsy. While the clinical trials evaluating the safety and efficacy of these ablation techniques are in their early stages, initial results are promising in the treatment of various cancers at different stages. These include potential synergistic effects when combined with chemotherapy and immunotherapy.

BACKGROUND. Coronary artery calcium (CAC) scoring is used to stratify acute coronary syndrome (ACS) risk. Nonetheless, patients with a CAC score of zero (CAC0) remain at risk from noncalcified plaque components. OBJECTIVE. The purpose of this study was to explore CTA-derived coronary artery plaque characteristics in symptomatic patients with CAC0 who subsequently have ACS through comparisons with patients with a CAC score greater than 0 (CAC> 0) who subsequently have ACS as well as with patients with CAC0 who do not subsequently have ACS. METHODS. This study entailed a secondary retrospective analysis of prior prospective registry data. The international multicenter CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter) registry collected longitudinal observational data on symptomatic patients who underwent clinically indicated coronary CTA from January 2004 to May 2010. ICONIC (Incident Coronary Syndromes Identified by CT) was a nested cohort study conducted within CONFIRM that identified patients without known coronary artery disease (CAD) at the time of CTA who did and did not subsequently have ACS (i.e., the ACS and control groups, respectively) and who were propensity matched in a 1:1 ratio on the basis of CAD risk factors and CAD severity on CTA. The present ICONIC substudy selected matched patients in the ACS and control groups who both had documented CAC scores. CTA examinations were analyzed using artificial intelligence software for automated quantitative plaque assessment. In the ACS group, invasive angiography findings were used to identify culprit lesions. RESULTS. The present study included 216 patients (mean age, 55.6 years; 91 women and 125 men), with 108 patients in each of the ACS and control groups. In the ACS group, 23% (n = 25) of patients had CAC0. In the ACS group, culprit lesions in the subsets of patients with CAC0 and CAC> 0 showed no significant differences in fibrous, fibrofatty, or necrotic-core plaque volumes (p > .05). In the CAC0 subset, patients with ACS, compared with control patients, had greater mean (± SD) fibrous plaque volume (29.4 ± 42.0 vs 5.5 ± 15.2 mm3, p < .001), fibrofatty plaque volume (27.3 ± 52.2 vs 1.3 ± 3.7 mm3, p < .001), and necrotic-core plaque volume (2.8 ± 6.4 vs 0.0 ± 0.1 mm3, p < .001). CONCLUSION. After propensity-score matching, 23% of patients with ACS had CAC0. Patients with CAC0 in the ACS and control groups showed significant differences in volumes of noncalcified plaque components. CLINICAL IMPACT. Methods that identify and quantify noncalcified plaque forms may help characterize ACS risk in symptomatic patients with CAC0.

Videotaped and closed circuit testimonies are often used in legal procedures, but little is known about the psychological effects of these courtroom technologies. The present thesis examines how different presentation modes affect observers’ perception, veracity assessment and memory. In Study I truth-telling and lying adult witnesses were interviewed. Mock jurors (N = 122) viewed the testimonies, either live or on video, and rated their perception and assessed the veracity of the witnesses’ statements. Live observers rated the witnesses’ appearance in more positive terms and assessed them as being more honest than did video observers. Furthermore, both live and video observers’ deception detection performance was at chance level (49.2% vs. 50.8%). Live observers incorrectly believed they had a better memory of the witnesses’ statements than video observers. Study ΙΙ was structurally similar to Study I (but used child witnesses). Mock jurors (N = 136) viewed truth-telling and lying children’s testimonies (either live or on video), rated their perception of the children and assessed the children’s veracity. Live observers rated the children’s statements as being more convincing than did video observers. The overall deception detection performance was 59.6%, which was significantly different from the level of chance. Live observers were better than chance, but not better than the video observers, in assessing veracity. Moreover, live observers believed they had a better memory of the children’s statements than video observers, and they also showed a significantly better memory performance. In Study III truth-telling and lying children were viewed and assessed by adult mock jurors (N = 240) either live, via two-way closed-circuit television (CCTV), or via pre-recorded video. The mock jurors rated their perception of the children’s testimonies and assessed the children’s veracity. The results showed that live observers perceived the children in more positive terms than did the CCTV observers, who in turn perceived the children in more positive terms than did the video observers. The observers’ overall deception detection accuracy was mediocre (58.3%). Study IV investigated the effects of different camera perspectives on adults’ perception and assessment of videotaped child testimonies. Truth-telling and lying children were interviewed and videotaped simultaneously by four cameras, each taking a different visual perspective (close-up shot/child only, medium shot/child only, medium shot/child and interviewer, long shot/child and interviewer). Mock jurors (N = 256) rated their perception of the children and assessed the veracity of the statements. Children seen in long shot were perceived in more positive terms, and children seen in close-up were perceived as having to think harder. The adult’s deception detection accuracy was at chance level. Taken together, the results showed that the presentation mode affected the observers’ perception of the witnesses’ testimonies. Thus, the thesis suggests that legal policy-makers should consider the outcome of psycho-legal research on different presentation modes when establishing and/or reforming standards for police interviews and courtroom procedures.

Introduction: Surveillance for endoleak after endovascular aortic aneurysm repair with computed tomography angiography has the associated risks of radiation exposure and nephrotoxic contrast agents. The purpose of this study was to evaluate the performance of contrast-enhanced ultrasound in the detection of endoleak post–endovascular aortic aneurysm repair. Methods: A single-center retrospective cohort study was performed evaluating patients with abdominal aortic aneurysm treated with endovascular aortic aneurysm repair between October 29, 2017 and April 21, 2021 and follow-up imaging with both computed tomography angiography and contrast-enhanced ultrasound. The sample included 35 imaging combinations in 28 patients. Positive and negative results for detection of endoleak by contrast-enhanced ultrasound were tabulated as true positive, false positive, true negative, and false negative compared to computed tomography angiography and conventional angiography. Sensitivity, specificity, positive predictive value, and negative predictive value of contrast-enhanced ultrasound were calculated. Results: Out of 35 imaging combinations, endoleak was detected in 24 cases by computed tomography angiography and in 23 cases by contrast-enhanced ultrasound. Using computed tomography angiography as the reference standard, contrast-enhanced ultrasound yielded 96% sensitivity, 100% specificity, 100% positive predictive value, and 92% negative predictive value for endoleak detection. In the 23 cases of endoleak detection by both contrast-enhanced ultrasound and computed tomography angiography, contrast-enhanced ultrasound discerned the correct endoleak type in all 23 cases, while computed tomography angiography identified the correct endoleak type in 20 cases ( P = .2333). Discussion: Endoleak detection by contrast-enhanced ultrasound appears at least equivalent to computed tomography angiography. Some of the advantages of contrast-enhanced ultrasound in the surveillance of endoleak after endovascular aortic aneurysm repair include an avoidance of radiation, elimination of nephrotoxic contrast agents, reduction in costs, real-time imaging, discerning flow directionality, and visualizing endoleaks in regions previously embolized with coils/plugs/liquid embolic agents. Limitations include operator dependence and variables that obscure the visual field including obese body habitus. With these advantages and excellent comparison data, contrast-enhanced ultrasound should be considered as a first-line imaging modality for long-term surveillance of endoleaks after endovascular aortic aneurysm repair. Conclusion: Contrast-enhanced ultrasound is a safe and viable option for long-term surveillance post–endovascular aortic aneurysm repair.

Atherectomy is an important option for debulking atherosclerotic plaque from diseased arteries in patients with infrainguinal arterial disease. Laser atherectomy uses a high-powered laser to remove the plaque from the arteries to restore blood flow. The Pathfinder multicenter registry was initiated to evaluate the safety and efficacy of the 355 nm laser atherectomy system in a real-world setting for the treatment of de novo, re-stenotic and in-stent restenosis (ISR) lesions in infrainguinal arteries of patients with peripheral artery disease (PAD). The study was a prospective, single-arm, multicenter, open-label registry study for patients treated with the 355 nm laser system. Clinical and lesion characteristics, procedural safety and efficacy data, and baseline, 6-, and 12-month outcomes data, including Ankle Brachial Index (ABI), Rutherford class, and Walking Impairment Questionnaires (WIQ), were collected. The primary efficacy endpoint was the achievement of ≤30% final residual stenosis at the index lesion postatherectomy and adjunctive therapy evaluated by an angiographic Core Lab. The primary safety endpoint was the percentage of subjects who did not experience periprocedural major adverse events (PPMAEs) before discharge. One hundred and two subjects with 121 lesions treated with the 355 nm laser device at 10 centers were included in the analysis. Mean age was 68.4 ± 10.21 years, 61.8% of subjects were male, 44.6% had critical limb ischemia (CLI), and 47.3% had tibial lesions. The mean residual stenosis at the end of the procedure was 24.4 ± 15.5 with 69 lesions (69.0%) achieving technical procedural success (<30% stenosis); similar rates were observed for subjects with ISR (25.5 ± 14.9), chronic total occlusion (CTO) (28.1 ± 17.0), and severe calcification (36.5 ± 21.6) lesions. Mean ABI, Rutherford, and WIQ scores were improved at both 6 and 12 months. Ninety-seven of 102 subjects (95.1%) met the primary safety endpoint of not experiencing a PPMAE before discharge. The initial data from the Pathfinder Registry demonstrates the 355 nm laser system is safe and effective in a real-world setting for performing atherectomy in patients with infrainguinal PAD.