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BackgroundDrug-coated balloons (DCBs), modern treatment for de novo coronary artery lesions, deliver antiproliferative drugs to the vessel wall during inflation.MethodsA prospective, all-comers database at Galway University Hospital recorded de novo lesions treated with Paclitaxel/ Sirolimus-DCBs between January 2021-March 2025. Data pertaining demographics, clinical presentation, and procedural characteristics were collected. Procedural outcomes were compared at index procedure (including; QCA analysed residual in-lesion stenosis >40%, and bailout stenting), and 30-day follow-up (including; cardiac death, and target lesion revascularisation). Statistical analysis performed using IBM SPSS.FindingsIn 82 patients, 94 de novo lesions treated, with 76.6% (lesions=72) receiving Paclitaxel. Mean age 66.8 years (SD 11.53); 86.5% male. Obesity (BMI >30) was significantly higher in Paclitaxel (34%) versus Sirolimus (0%,p=0.013), whilst CKD (stage3/4) was less frequent in Paclitaxel (16.9%) versus Sirolimus (33.4%, p=0.078). There was a non-significant trend toward greater Paclitaxel use in acute coronary syndrome (Paclitaxel 58.3% vs. Sirolimus 40.9%) , vessels >3mm (Paclitaxel 30.6% vs. Sirolimus 9%), bifurcations (Paclitaxel 18.1% vs. Sirolimus 4.5%), and long lesions >30mm (Paclitaxel 12.5% vs. Sirolimus 4.5%) compared to Sirolimus (p>.05 for all comparisons) (figure 1). Lesion preparation was similar between groups. Intracoronary imaging was used less frequently with Paclitaxel (8.3%) versus Sirolimus (54.4%, p <0.001).There was a non-significant trend towards lower percentage residual in-lesion stenosis (>40% by QCA measurement) with Paclitaxel versus Sirolimus (respectively 33.3% vs. 54.5%, p <.085) (figure 2). At 30-days, one Paclitaxel-DCB cardiac death occurred from decompensated heart failure; no target lesion revascularisations were reported.Abstract 75 Figure 1[Image Omitted. See PDF.]Abstract 75 Figure 2[Image Omitted. See PDF.]InterpretationAlthough Paclitaxel-DCBs were more frequently used in acute cases, complex lesions, and larger vessels, procedural outcomes and 30-day safety were similar to Sirolimus-DCBs. In a real-world setting, DCB for de novo lesions appears feasible and safe, even in complex cases, using a ‘leave-nothing-behind’ strategy.

IntroductionRecanalization rates are typically lower in ICA occlusions, with first-pass mTICI 2b-3 rates ranging from 30% to 50% due thrombus length and anatomical complexity. The NeVa stent retriever has demonstrated high recanalization effectiveness with a favorable safety profile in mechanical thrombectomy of LVOs.Aim of StudyNeVa ONE is a multicenter, international, prospective registry designed to assess outcomes in a real-world patient cohort.This interim analysis descriptively compares different lesion locations and corresponding recanalization outcomes.MethodThis analysis includes 350 patients treated using NeVa as a first-line approach.Outcomes are assessed across occlusions in the ICA, MCA (M1, M2), and BA.Endpoints include successful (TICI2b-3) and complete (TICI 2c-3) recanalization achieved at first pass (mFPE/FPE) and at procedure end.Secondary endpoints include device/procedure-related adverse events.ResultsOcclusion sites were: ICA (28.0%), M1 (57.1%), M2 (10.9%) and BA (4%).Baseline characteristics were comparable across lesion locations with slight deviations for the smaller-sized basilar artery group:Age 67–72 years, NIHSS 13–16, ASPECTS 8–10.Common comorbidities included hypertension (68–75%), dyslipidemia (43–50%), diabetes (20–33%), and atrial fibrillation (25–43%).mFPE rates were 66.7% (ICA), 77% (MCA M1), 81.6% (MCA M2), and 71.4% (BA).Corresponding FPE rates were 53.5%, 65%, 52.6%, and 50%.ConclusionThe NeVa ONE Registry reflects real-world outcomes for LVO AIS patients treated with NeVa.Recanalization rates for ICA occlusions were comparable to other lesion locations, highlighting NeVa’s consistent performance across complex territories.Conflict of InterestNo

In healthy blood vessels, vascular smooth muscle cells (VSMCs) exist in a contractile, quiescent state but can switch phenotype to activate proliferation, migration and remodelling of the extracellular matrix. Phenotypically switched VSMCs contribute most cells within neointimal lesions, characteristic of atherosclerosis and in-stent restenosis, diseases that underlie heart attack and stroke. Using multicolour ‘Confetti’ VSMC-specific lineage tracing in animal models of vascular disease, we showed that the extensive VSMC contribution to these lesions results from the clonal expansion of few cells.To understand how oligoclonal VSMC lesion contribution arises and to identify the signals activating VSMC proliferation in vivo, we used confocal microscopy to quantify VSMC clonal development over time in two models of vascular disease. We observed that the number and sizes of patches of clonally expanded VSMCs steadily increased, then plateaued post-injury. This suggests VSMC investment results from activation of a small number of VSMCs, rather than clonal competition following general VSMC activation. Selective VSMC activation in plaques was evidenced by the absence of plaques with high numbers of colours at any stage of plaque development.In both models, VSMC activation was associated with vascular regions displaying elastic lamina alterations, medial acellularity and immune cell recruitment, implicating these as proliferation-triggering cues. However, not all VSMCs in these regions formed patches, suggesting that VSMCs must be primed to respond. In culture, few VSMCs gave rise to patches, suggesting cell-autonomous activation. This work supports the targeting of primed VSMCs in the healthy vessel as a therapeutic strategy against vascular lesion development.Conflict of InterestNone

Like cervical cancer, anal cancer is often caused by a human papillomavirus and has a premalignant stage called high-grade squamous intraepithelial lesion or anal intraepithelial neoplasia. A randomized trial showed that treating HSIL led to a 57% reduction in progression to anal cancer as compared with active surveillance.

Objectives: “Kissing lesions” are femoral neck injuries that arise from repetitive contact between the femoral neck and the acetabulum in patients with femoroacetabular impingement syndrome. Historically, kissing lesions are thought to occur at a state of deep hip flexion beyond 90 degrees. However, this angle has not been quantified in vivo and will therefore be the purpose of this study. Methods: Patients undergoing a primary hip arthroscopy with intraoperatively identified kissing lesions were included. Patients were flexed at the hip until the labrum began to engage the kissing lesion. Photos were taken at this position and degree of hip flexion was calculated (Figure 1). Comparisons were made via two-tailed t-tests. Additionally, all available preoperative PROMIS v2.0 – Physical Function scores were reviewed and placed into a linear regression model to determine if there was an association between preoperative function and kissing lesion angle. Results: A total of 112 patients were analyzed in this study. Mean age was 30.5 ± 10.7 years, mean BMI was 26.2 ± 5.6, 39 were males, and 73 were females. Mean degree of hip flexion to achieve a kissing lesion was 63.1 ± 11.6 degrees with a range from 39.8 to 94.9 degrees across all patients. Males had a mean flexion angle of 65.9 ± 10.8 degrees compared to females who had a mean flexion angle of 61.6 ± 11.7 (p=0.064) to achieve a kissing lesion. Patients <18 (n=19) had an average flexion of 61.8 ± 12.6 compared to patients >18 (n=93) having a mean of 63.4 ± 10.9 (p=0.090) to achieve a kissing lesion. There was no significant association between degree of flexion and preoperative PROMIS scores (Figure 2). Conclusions: On average, patients required 63 degrees of flexion to engage their arthroscopically identified kissing lesions, with very few requiring >90 degrees flexion. This finding challenges the previously held notion that these lesions are a deep flexion issue and may explain why some patients experience discomfort at lower flexion angles. However, the degree at which a person engages their kissing lesion does not appear to impact their preoperative PROMIS score.

[This retracts the article DOI: 10.7759/cureus.73776.].

Category: Sports; Trauma Introduction/Purpose: If tibiofibular syndesmosis injury is missed, chronic instability may lead to persistent pain and osteoarthritis. So far, no reliable diagnostic method has been available. The primary objectives of this study were to determine whether defined lesions of the syndesmosis can be correlated with specific tibiofibular joint displacements caused by external rotation (ER) torques and to compare its performance with arthroscopy. Secondary objectives included evaluation of Intraclass-Correlation-Coefficients (ICCs) and suitability of the healthy contralateral ankle as a reference. Methods: Seven pairs of healthy lower legs were tested and assigned to two groups (1) Supination-ER (SER) and (2) Pronation-ER (PER). In the intact state and after each surgical step, an ankle arthroscopy and three CT scans were performed. During the scans, the specimens were placed in an external torque device with 2.5Nm, 5Nm and 7.5Nm. Results: The arthroscopic and radiological parameters showed significant correlations in all pairwise comparisons. The receiver operating curve (ROC) analyses yielded best prediction of syndesmotic instability with the anterior tibiofibular distance (AD) on CT with a sensitivity of 84.1% and a specificity of 95.2% (area under the curve (AUC) 94.8%, CI 0.916-0.979, p< 0.0001) and middle tibiofibular distance at arthroscopy with a sensitivity of 76.2% and specificity of 92.3% (AUC 91.2%, CI 0.837-0.987, p< 0.0001). Higher torques increased the rate of true positive results. Conclusion: Bilateral external torque CT reliably detects experimental syndesmotic rotational instability compared to the healthy side with greater sensitivity and similar specificity to the arthroscopic lateral hook test. Translation of these experimental findings to clinical practice remains to be established.

Objectives: The on-track/off-track concept for shoulder instability primarily describes the medial-lateral rotational relationship between an engaging Hill-Sachs lesion and a Bankart defect. Though clinically more protective, on-track lesions retain some risk for failure following primary arthroscopic Bankart repair. While some of this risk can be explained by the “near-track” concept, the role of the superior-inferior position of the Hill-Sachs lesion has never been studied in the context of failure of primary Bankart repair. This study aims to identify the relationship between the superior-inferior position of a Hill-Sachs lesion and risk for failure following primary arthroscopic bankart repair. Our hypothesis is that inferiorly-based Hill-Sachs lesions may engage with the arm in neutral and thus be higher risk for failure following primary Bankart repair. Methods: We performed a retrospective analysis of 201 individuals with on track lesions who underwent primary arthroscopic Bankart repair (without remplissage) between 2007 and 2019 who have minimum 2 year follow-up. Patients with failure were defined as those who sustained a dislocation or subluxation after the index procedure. A pre-operative sagittal MRI cut showing the maximum Hill-Sachs diameter was used for position analysis. Sagittal position of the Hill-Sachs was defined the angle formed by the Hill-Sachs bisecting line through the humeral head center, against the mid-humeral axis on a sagittal MRI cut (Figure 1); for example, an angle of 0 is twelve o’clock on the humeral head, while an angle of 90 is equatorial. We defined a priori four Hill-Sachs quadrants for semi-quantitative analysis, based on physiologic arm positions: Superior (angle < 40), Mid-Superior (40-60), Mid (61-90), and Inferior (>90). Hill-Sachs quadrants were then correlated against failure following primary arthroscopic Bankart repair. Results: Failure rates following arthroscopic bankart repair as it relates to superior-inferior position of the Hill-Sachs lesion is as follows (Table 1): No Hill-Sachs (10 of 73, 13.7%), Superior (0 of 7, 0%), mid-superior (6 of 36, 16.7%), Mid (19 of 71, 26.8%), and Inferior (1 of 6, 16.7%). We grouped Hill-Sachs lesions into low grade (No Hill-Sachs, Superior, and Mid-Superior quadrants) and high grade (Mid and Inferior quadrants). Low grade represented a 13.8% risk of failure, while High grade represented a 26% risk for failure (p=0.034). Conclusions: The superior-inferior sagittal position of a Hill-Sachs lesion may contribute to risk for failure of primary arthroscopic Bankart repair for on-track lesions. Inferiorly-based Hill-Sachs lesions may risk engagement at lower degrees of arm abduction, and in our study represent nearly double the risk of failure of arthroscopic Bankart repair as compared to superior Hill-Sachs positions.