Identification of patients with high-risk asymptomatic carotid plaques remains a challenging but crucial step in stroke prevention. Inflammation is the key factor that drives plaque instability. Currently, there is no imaging tool in routine clinical practice to assess the inflammatory status within atherosclerotic plaques. We have developed a molecular magnetic resonance imaging (MRI) tool to quantitatively report the inflammatory activity in atherosclerosis using dual-targeted microparticles of iron oxide (DT-MPIO) against P-selectin and VCAM-1 as a smart MRI probe. A periarterial cuff was used to generate plaques with varying degree of phenotypes, inflammation and risk levels at specific locations along the same single carotid artery in an Apolipoprotein-E-deficient mouse model. Using this platform, we demonstrated that in vivo DT-MPIO-enhanced MRI can (i) target high-risk vulnerable plaques, (ii) differentiate the heterogeneity (i.e. high vs intermediate vs low-risk plaques) within the asymptomatic plaque population and (iii) quantitatively report the inflammatory activity of local plaques in carotid artery. This novel molecular MRI tool may allow characterisation of plaque vulnerability and quantitative reporting of inflammatory status in atherosclerosis. This would permit accurate risk stratification by identifying high-risk asymptomatic individual patients for prophylactic carotid intervention, expediting early stroke prevention and paving the way for personalised management of carotid atherosclerotic disease.

Aortic aneurysms are a rare cardiovascular complication of Systemic Lupus Erythromatosus (SLE) and the true incidence is unknown. This case report shares our experience with a 40 year old lady suffering from SLE whose Abdominal Aortic Aneurysm (AAA) was treated successfully with endovascular aneurysm repair (EVAR). To the author's knowledge, the use of EVAR for AAA in SLE patients has not been reported in available literature. The pathogenesis and differences in aneurysmal disease in patients with SLE is also discussed.

Purpose: To report a candy-plug technique using a Zenith Alpha stent-graft to occlude the distal false lumen in a patient with a complicated chronic type B aortic dissection. Case Report: A 50-year-old male smoker presented with chest pain due to rapidly growing complicated chronic type B aortic dissection. Computed tomography angiography (CTA) showed the dissection extending from distal to the origin of the left subclavian artery (LSA) down to the left femoral artery. There was fusiform aneurysmal dilatation of the proximal descending aorta measuring up to 5.8 cm in diameter. He underwent left carotid–subclavian artery bypass, thoracic endovascular aortic repair with a Zenith Alpha stent-graft, a left common carotid artery chimney, and embolization of the proximal LSA. Serial CTA showed persistent false lumen flow. A decision was made to occlude the distal large false lumen using the candy-plug technique. A 44×125-mm Zenith Alpha stent-graft was used to prepare the candy plug. A gutter leak and a type Ia endoleak were embolized via a left brachial artery approach. At 2.5 years, imaging showed the candy plug in position, no endoleak, and the thrombosed false lumen in the thoracic aorta reduced in size. Conclusion: The candy-plug technique is useful in facilitating complete occlusion of the false lumen in chronic aortic dissection, which avoids an open procedure and the risk of higher morbidity.

versus plain balloon angioplasty (PBA) for the treatment of symptomatic central venous stenosis in dialysis access. Materials: Between January 2014 to August 2015, 40 dialysis patients with symptomatic central venous stenosis were randomized (1:1) to undergo either dilation with a 2μg/mm2 PCB (group PCB, n¼20) or PBA (group PBA, n¼20). Both de novo and restenotic [15/20; (75%) group PCB and 12/20; (60%) group PTA] lesions were treated. Primary endpoints were technical success and lesion primary patency (LPP). Secondary endpoints included complication rates and circuit primary patency. Individual subgroup longitudinal analysis was performed to compare outcomes of PCB versus previous treatment in the same patients for restenotic lesions in group PCB. Results: Until today, 6-month follow up is available in 14/20 (70%) cases in group PCB and in 18/20 (90%) cases in group PBA. According to Kaplan Meier analysis, LPP is 60% for group PCB and 45% for group PBA [p¼0.094; HR: 0.48 (95% CI: 0.201-1.13)]. Longitudinal analysis between treatments show a statistically significant difference in favor of PCB treatment compared to previous PBA [9/15 (60%) vs. 4/12 (33.3%); p¼0.001 HR: 4.39 (95%CI: 1.79-10.78]. Conclusions: Interim results of this prospective randomized trial show a trend to improved patency for PCB in the treatment of symptomatic central venous stenosis. Final results will be announced.

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