ObjectivesIntravascular lithotripsy (IVL) is a novel clinical technique for the management of severely calcified lesions. However, the biological effects of shock wave on the healthy arterial tissue have not been demonstrated. The preclinical safety study aimed to investigate the vascular response to IVL shock wave compared to plain old balloon angioplasty (POBA) in porcine peripheral arteries.MethodsThe left and right iliofemoral arterial segments of 16 mini-pigs were subjected to IVL and POBA, respectively. The vascular response was evaluated using quantitative vascular angiography (QVA), light microscopy, and scanning electron microscopy (SEM) at 0, 5, and 28 days.ResultsWith the emission of shock wave, adjacent muscle contraction was observed. QVA showed there was no statistically significant difference in percent diameter stenosis and late lumen loss between the two groups. SEM examination showed the endothelial cell layer was intact in both groups at all timepoints. Under light microscopy, no area stenosis was observed. However, IVL shock wave resulted in significantly higher percent area stenosis and intimal area at 28 days. Neointima score showed a trend toward a higher rate in the IVL group, although there was no statistically significant difference at 28 days. There were no statistically significant differences in the scored parameters between groups at all timepoints. However, the parameters of inflammation and neointima showed a trend toward higher scores in the IVL group. After disruption of the internal elastic lamina, the arteries demonstrated significantly neointimal thickening.ConclusionsThe safety and operability of IVL are comparable to POBA. The histological response of healthy arteries to IVL shock wave is mild and sustained. IVL shock wave do not cause serious vascular tissue damage, especially endothelial denudation.

Aortic dissection is a highly fatal disease with limited predictability requiring emergency response. It remains a challenging clinical problem and has a reported lower 5-year survival rate, especially in acute cases. Studying the epidemiology of aortic dissection can be important for targeting key populations and developing public health policies. Past studies have focused more on the in-hospital and follow-up mortality associated with aortic dissection but the global epidemiology review is still lacking. Incidence data have rarely been generated or provided. We estimated and analyzed the incidence of aortic dissection in all 195 countries and 54 regions worldwide and in the population structures of 15 selected countries. We further reviewed risk factors and baseline characteristics related to aortic dissection. We outlined the topic in terms of the biological, social, environmental, and psychosocial factors. Public health departments should screen target groups and key regions and introduce policies for disease prevention and relieve the high medical burdens.

ObjectivePrevious reports have revealed a high incidence of type II endoleak (T2EL) after endovascular aneurysm repair (EVAR). The incidence of T2EL after EVAR is reduced by pre-emptive embolization of aneurysm sac side branches (ASSB) and aneurysm sac coil embolization (ASCE). This study aimed to investigate whether different preventive interventions for T2EL were correlated with suppression of aneurysm sac expansion and reduction of the re-intervention rate.MethodsThe PubMed, Web of Science, MEDLINE and Embase databases, and conference proceedings were searched to identify articles on EVAR with or without embolization. The study was developed in line with the Participants, Interventions, Comparisons, Outcomes, and Study design principles and was conducted and reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. We used network meta-analysis based on multivariate random-effects meta-analysis to indirectly compare outcomes of different strategies for embolization during EVAR.ResultsA total of 31 studies met all inclusion criteria and were included in the qualitative and quantitative syntheses. The included studies were published between 2001 and 2022 and analyzed a total of 18,542 patients, including 1,882 patients who received prophylactic embolization treatment during EVAR (experimental group) and 16,660 who did not receive prophylactic embolization during EVAR (control group). The effect of pre-emptive embolization of the inferior mesenteric artery (IMA) (IMA-ASSB) in preventing T2EL was similar (relative risk [RR] 1.01, 95% confidence interval [CI] 0.38–2.63) to the effects of non-selective embolization of ASSB (NS-ASSB) and ASCE (RR 0.88, 95% CI 0.40–1.96). IMA-ASSB showed a better clinical effect in suppressing the aneurysm sac expansion (RR 0.27, 95% CI 0.09–2.25 compared with NS-ASSB; RR 0.93, 95% CI 0.16–5.56 compared with ASCE) and reducing the re-intervention rate (RR 0.34, 95% CI 0.08–1.53 compared with NS-ASSB; RR 0.66, 95% CI 0.19–2.22 compared with ASCE). All prophylactic embolization strategies improved the clinical outcomes of EVAR.ConclusionProphylactic embolization during EVAR effectively prevents T2EL, suppresses the aneurysm sac expansion, and reduces the re-intervention rate. IMA embolization demonstrated benefits in achieving long-term aneurysm sac stability and lowering the risk of secondary surgery. NS-ASSB more effectively reduces the incidence of T2EL, while IMA embolization alone or in combination with ASCE enhances the clinical benefits of EVAR. In addition, as network meta-analysis is still an indirect method based on a refinement of existing data, more studies and evidence are still needed in the future to establish more credible conclusions.