Vessel ischemic disease

Therapeutic angiogenesis is an emerging strategy for treating ischemic diseases by inducing new blood vessel growth in... 

Fig. 2. Proposed process of arteriosclerosis leading to ischemic disease. It is proposed that arteriosclerosis is a process of inflammation within the arterial wall that is initiated by arterial injury (endothelial dysfunction), causing the trapping of lipoproteins (Rll, Zl). These undergo oxidation as proposed in Fig. 1, leading to foam cells saturated with lipid droplets. Continued accumulation of fatty material within the blood vessel wall promotes a fatty streak. Ultimately, there is muscle cell migration and fibrosis leading to a plaque that consists of a fibrous cap with cholesterol crystals and debris within the deep necrotic layer, while inflammatory cells form a dynamic outer edge. It is thought that oxidized lipoproteins can facilitate many of these processes. Mechanical forces predispose the soft outer layer of the plaque to rupture at sites of structural weakness. Rupture of plaques causes thrombosis and incorporation of thrombi into the plaque. Ultimately, a large thrombus appearing in an obstructed vessel can lead to sudden ischemia and unstable coronary syndromes.

Mast cells are present in the normal human heart and even more abundant in diseased hearts [ 16-18,25,47]. Within heart tissue, mast cells he between myocytes and are in close contact with blood vessels. They are also found in the coronary adventitia and in the shoulder regions of coronary atheroma [20, 21], The density of cardiac mast cells is higher in patients with dilated and ischemic cardiomyopathy than in accident victims without cardiovascular diseases [25], Importantly, in some of these conditions there is in situ evidence of mast cell activation [16,34],... 

Review of postcontrast CTA source images might provide a good estimate of whole-brain perfusion." If time allows, MR or CT perfusion maps are obtained to characterize more accurately the ischemic penumbra." Careful but expedited preprocedural analysis of the CTA, done in parallel with transport of the patient to the treatment area, may be extremely helpful in establishing the presence of anatomic variants (e.g., bovine aortic arch) or pathological states (e.g., vessel origin or carotid bifurcation disease) prior to the catheterization procedure. 

The fact that the microbubbles are restricted to the vascular space makes them ideal for contrast echocardiography and vascular imaging. Echocardiography is used extensively to assess ischemic heart disease. Contrast-enhanced echocardiography improves visualization of the cavities of the heart, the lumen of arteries and veins, and small vessels within solid organs and perfused tissues. Effective endocardial border delineation allows assessment of global heart function and the detection of coronary insufficiency (Fig. 12). 

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