Underlying Subclavian Artery Occlusion Initially Misdiagnosed in ...

Scientists Study The Evolutionary Origins Of Coronary Arteries

Coronary arteries are a vital part of the human heart, providing it with oxygen-rich blood so that it can work. By comparing the hearts of mammals, birds, reptiles, fish and frogs, a multi-institutional team of researchers appears to have found evidence that the structure of our hearts evolved in a stepwise process from fish, through amphibians to reptiles to mammals.

When animals evolved from living in the water to living on land, a significant remodeling of the blood vessels to the heart occurred, enabling survival without gills. Understanding the ancestral origins of our cardiovascular system could help us find the basis for certain genetic defects. Knowing the systems of various other animals also broadens the scope for studying heart disease and potential treatments.

How do you take care of your heart? Being active, reducing stress and eating heart-healthy foods can all help to protect and strengthen this vital organ. Unfortunately, congenital heart disease (CHD) is the most common birth defect worldwide.

CHD refers to a range of issues, including anomalous coronary artery, where the coronary arteries are malformed. These arteries supply the heart with oxygenated blood, so if they are not properly developed then it can cause sudden and dangerous complications. But not all species have this problem. There are animals including fish and amphibians whose hearts don't have or need coronary arteries. So why do we and where did they come from?

To help answer these questions, researchers in Japan compared the development of blood vessels in the hearts of mice, Japanese quails, newts, zebrafish, sharks and frogs. The work is published in the journal eLife.

The team used a combination of techniques, including MRI, micro-CT scans, sectioning (analyzing thin slices of the hearts under a microscope) and 3D reconstruction, to create detailed images. By comparing these images, they could see the difference in how the blood vessels (vascular system) develop in the hearts of amniotes, i.E., mammals, birds and reptiles, and non-amniotes, i.E., fish, sharks and amphibians, from embryos to adults.

"In fish, sharks and amphibians, a long vascular system extending from the gills supplies blood to the heart. By contrast, in mammals and birds, this ancestral vasculature exists only during the embryo stage and later transforms into adult coronary arteries which are wrapped around the heart. This evolutionary change is likely connected to the transition of vertebrates from water to land, which led to the loss of gills," explained researcher Hiroki Higashiyama from the Department of Physiological Chemistry and Metabolism at the Graduate School of Medicine at the University of Tokyo.

Amphibians sit in between fish and mammals on the evolutionary tree and so may offer some insight as to how one type of heart evolved into the other. "As an example, we saw that the transient blood vessels observed in mice embryos bore a striking resemblance to the ancestral vascular system found in amphibians," said Higashiyama. "As the mouse's coronary arteries form, these ancestral vessels disappear, but they act as essential starting points for creating the new coronary arteries."

The results appeared to show that the structure of the human heart originated from a common amniote ancestor. When this animal transitioned from being a water dweller to living on land, an important development took place which involved significant remodeling of ancestral blood vessels to form the coronary arteries we have today.

This image shows the similarities between the transient blood vessels (pink), called aortic subepicardial vessels (ASVs), in the hearts of frogs and mice. As the mice grow into adulthood, these vessels disappear and coronary arteries form. In frogs, these vessels are maintained throughout their lives. Credit: 2023, Mizukami et al.

In non-amniotes, like fish, the arteries supplying oxygen to the heart originate directly from the gills. In amniotes, such as mice, these vessels, known as aortic subepicardial vessels (ASVs), undergo reorganization during development to form novel coronary arteries that branch near the heart. This evolutionary change is likely linked to the loss of gills during the transition to a terrestrial lifestyle. Credit: 2023, H. Higashiyama

The researchers speculated that this was necessary to enable a thickening of the human heart's ventricle wall, so that it could handle high physiological activity, such as the elevated blood pressure that maintains amniotes' high metabolic capacity (the ability to take on oxygen and circulate it in the blood).

"This research broadens the range of animal models available for studying heart diseases and their treatments," said Higashiyama. "Next we would like to gain a deeper understanding of the molecular processes involved in coronary artery remodeling. By doing so, we can uncover the mechanisms of 'how' the mammalian- and reptilian-type coronary arteries evolved and potentially shed light on human congenital heart abnormalities and diseases."

More information: Kaoru Mizukami et al, "Coronary artery established through amniote evolution," eLife (2023), DOI: 10.7554/eLife.83005.

Journal information: eLife

Citation: Scientists study the evolutionary origins of coronary arteries (2023, August 22) retrieved 26 August 2023 from https://phys.Org/news/2023-08-scientists-evolutionary-coronary-arteries.Html

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'It Can Kill You': Retiree Urges Awareness Of Carotid Artery Disease

John Davis' resume includes serving as a test engineer of radar systems on the Apollo modules that went to the moon. The retired engineer knows firsthand about the value of testing, minding details and solving problems.

So, when an otherwise routine medical test revealed that Davis' carotid arteries were severely blocked, he wasted no time taking care of it through a procedure called transcarotid artery revascularization.

TCAR is designed to treat blockages in the carotid arteries with less risk of perioperative stroke, heart attack or nerve damage than other procedures.

Now Davis, 84, is committed to sharing his story and encouraging others to be tested for carotid artery disease, which can lead to stroke, disability and death, even while — as in Davis' case — it may display no symptoms.

A disease with no symptoms

The carotid arteries carry blood from the heart through the neck to the brain, said Dr. Eddy H. Luh, a board-certified vascular surgeon at Vegas Vascular Specialists and chief of surgery at Valley Hospital Medical Center. Carotid artery disease occurs when there is a narrowing or obstruction along that blood flow, Luh explained.

The reduced blood flow can cause a stroke, in which the brain becomes starved for oxygen. Or bits of plaque may break off, travel to the brain and cause a stroke. Or the plaque deposits could create arterial blockages in the heart and legs.

"Stroke is one of the three leading causes of death in the United States," Luh said. About one-third of stroke patients die within 30 days, a third suffer some sort of permanent disability, and a third recover completely, the vascular surgeon said.

Unfortunately, carotid artery disease usually has no symptoms and is typically discovered only when a primary care doctor orders a routine ultrasound screening because of a patient's risk factors.

"Unfortunately, upward of 80 percent of the time … the first symptom is a stroke," Luh said of carotid artery disease.

If an ultrasound screening detects possible arterial narrowing, then a more precise test, a CT angiogram of the neck, may be administered.

Generally, carotid arterial blockages of less than 60 percent are treated with blood-thinning medications and therapy, Luh said. For more significant blockages, surgery is typically recommended.

Reducing surgical risks

During a surgical procedure called a carotid endarterectomy, or CEA, an incision is made in the neck and a surgeon "goes down the artery to tease the plaque out," Luh said.

One risk of CEA is that debris may escape, flowing to the brain and potentially causing a perioperative stroke. According to Luh, CEA has a stroke risk of about 2.5 percent when done by a board-certified vascular surgeon.

Also with CEA, the neck incision carries a 6 to 9 percent risk of damaging cranial nerves, including those associated with the vocal cords, the tongue and the ability to swallow, Luh said.

TCAR aims to reduce those risks. It uses a technology that temporarily reverses blood flow away from the brain as the blockage is cleared and a stent is placed to open the artery, reducing the risk of plaque traveling to the brain and causing a perioperative stroke, Luh said.

And TCAR uses smaller incisions in different locations than in CEA, he said, reducing the risk of nerve damage.

TCAR carries a less than 2 percent risk of stroke and a less than 1 percent risk of nerve injury, according to Luh. Most patients are hospitalized for one day, he added.

Undergoing TCAR

Davis said he felt some anxiety about having the procedure but is pleased with how it went.

"I woke up in recovery and I felt like it was before I went in," he said. "I asked (a nurse), 'Did we do the procedure?' 'Oh, it's all done.' "

The blockages in Davis' arteries were discovered during a routine primary care visit. When his physician suggested that he see a vascular specialist, Davis found Luh, who said that a CT angiogram revealed a blockage of almost 90 percent in Davis' left carotid artery and more than 70 percent blockage in his right.

Davis had one TCAR procedure in late February 2020 and the second about six weeks later. Now he says he feels great.

"My brain is getting better blood flow. I asked Dr. Luh, 'Will it make me smarter?' He said no," Davis joked.

The importance of screening

Luh said that he is the first physician in Nevada to perform TCAR, having first done the procedure in January 2020 at Valley Hospital.

He suggests that patients diagnosed with carotid artery disease discuss all of their options with their physician. Whether TCAR is the best solution depends on issues such as age, weight, location of the blockage and even a person's neck anatomy, he said.

Davis encourages everyone to talk with their physicians about being screened for carotid artery disease.

He had no symptoms and no family history of stroke, he said. "That's the whole thing about this, and that's the message you have to get out to people: It's life-threatening. It can kill you if you don't take care of it."

Being screened is particularly important for people who have vascular problems in other parts of their body. Carotid artery disease is a form of atherosclerosis — sometimes referred to as hardening of the arteries — "which is a systemic disease," Luh said. It's not uncommon for people with coronary heart disease or circulation problems in their legs or feet to suffer from arterial blockages elsewhere.

That was the case for Davis, who said that he later underwent procedures on both legs to address narrowed blood vessels.

Assessing CAD risk

Some of the factors that can put you at risk for carotid artery disease:

— Being older, especially for men.

— Diabetes.

— Family history of stroke or coronary artery disease.

— High blood pressure.

— High cholesterol.

— High triglycerides.

— Smoking.

— Alcohol use.

— Recreational drug use.

— Neck trauma.

Valley Health System

Global Vascular Graft Market Size To Reach USD 7.74 Billion 2032Emergen Research

Emergen Research

Increasing aging population and rising prevalence of aneurysm are key factors driving market revenue growth

Vancouver, Aug. 24, 2023 (GLOBE NEWSWIRE) -- The anticipated trajectory of the global vascular graft market points towards reaching a substantial valuation of USD 7.74 Billion by the year 2032. This projection is underpinned by a consistent and gradual Compound Annual Growth Rate (CAGR) of 7.3% throughout the forecast period, as evidenced by the latest analysis conducted by Emergen Research.

One of the primary drivers behind this upward trend is the escalating prevalence of Cardiovascular Diseases (CVD). This notable health concern underscores the importance of vascular grafts as a pivotal element in the healthcare landscape. Afflictions like Coronary Artery Disease (CAD), Peripheral Artery Disease (PAD), and aneurysms, which are encompassed within the spectrum of CVD, necessitate the intervention of vascular graft surgeries. The widespread occurrence of these diseases globally has underscored the imperative for efficacious therapeutic interventions, thus propelling the demand for vascular grafts. These grafts play a pivotal role in critical medical procedures, such as bypass surgery or arterial repair/replacement, especially among the elderly patient demographic.

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The robust expansion of the vascular graft market can be attributed to the proactive engagement of healthcare professionals who are earnestly addressing the mounting requisites for cardiovascular treatments. Furthermore, the landscape is being invigorated by transformative technological advancements that bolster the safety, efficacy, and longevity of vascular grafts. Innovations in the form of biocompatible materials, refined graft designs, and minimally invasive surgical methodologies collectively contribute to enhancing the overall market dynamics. This concerted push toward innovation not only augments patient outcomes but also fuels the economic growth of the market.

Story continues

It's important to acknowledge that there exist factors that could potentially impede the otherwise promising trajectory of revenue growth in the vascular graft market. One such factor is the occurrence of product failures and subsequent recalls. In-depth analysis conducted by Gore revealed that these mislabeling scenarios held the potential to lead to adverse consequences for patients. The paramount commitment of Gore to uphold the utmost quality standards drove the decision to conduct this recall. This proactive approach underscores the significance of patient safety and aligns with the industry's endeavor to ensure the efficacy and reliability of medical products. Instances such as these emphasize the pivotal role of stringent quality control measures and post-market surveillance in maintaining the integrity of the vascular graft market. While challenges such as product recalls can pose obstacles, they also serve as catalysts for reinforcing a culture of safety and continual improvement within the industry.

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Scope of Research

Report Details

Outcome

Market size in 2022

USD 3.80 Billion

CAGR (2023-2032)

7.3%

Revenue forecast to 2032

USD 7.74 Billion

Base year for estimation

2022

Historical data

2019-2021

Forecast period

2023-2032

Quantitative units

Revenue in USD Billion and CAGR in % from 2023 to 2032

Report coverage

Revenue forecast, company ranking, competitive landscape, growth factors, and trends

Segments covered

Raw material, indication, end-use, region

Regional scope

North America, Europe, Asia Pacific, Latin America, and Middle East & Africa

Country scope

U.S., Canada, Mexico, Germany, U.K., France, Spain, BENELUX, Rest of Europe, China, India, Japan, South Korea, Rest of APAC, Brazil, Rest of LATAM, Saudi Arabia, UAE, Israel, Rest of MEA

Key companies profiled

B. Braun SE, BD, Cook, Cordis, ENDOLOGIX LLC, Getinge, LeMaitre Vascular, Inc., Medtronic plc, Terumo Medical Corporation, and W. L. Gore & Associates, Inc.

Customization scope

10 hours of free customization and expert consultation

Major Companies and Competitive Landscape

The global vascular graft market is fragmented, with many large and medium-sized players accounting for the majority of market revenue. Major players are deploying various strategies, entering into mergers & acquisitions, strategic agreements & contracts, developing, testing, and introducing more effective vascular graft services. Some major players included in the global vascular graft market report are:

B. Braun SE

BD

Cook

Cordis

ENDOLOGIX LLC

Getinge

LeMaitre Vascular, Inc.

Medtronic plc

Terumo Medical Corporation

W. L. Gore & Associates, Inc.

Strategic Development

On 26 May 2022, a USD 3 million CIRM grant was awarded to UC Davis to create a smart vascular graft ffor renal patients. This apparatus employs a special chemical that directs the body's own stem cells in an effort to reduce the failure rate of artificial vascular grafts. Patients receiving hemodialysis for renal illness frequently experience such failures.

On 6 January 2020, Kipsbay Medical Inc., which is an innovator in the fields of venous external stenting and vascular engineering, produced and controlled a number of patent families that Vascular Graft Solutions (VGS) acquired from NEOGRAFT Technologies Inc.

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Some Key Highlights From the Report

The polyester grafts segment is expected to account for largest revenue share during the forecast period. Increasing prevalence of cardiovascular diseases and rising demand for vascular bypass procedures have both had positive impact on increasing use of polyester grafts. These grafts are a well-liked alternative due to their favorable traits and affordability, which is driving revenue growth of the segment.

The endovascular aneurysm repair segment is expected to account for largest revenue share during the forecast period. Vascular grafts serve as the stent grafts that sustain the aneurysm's structure and seal it off, making them crucial to endovascular aneurysm repair procedures. Increasing preference for endovascular aneurysm repair as a method of treating abdominal aortic aneurysms is driving revenue growth of the segment.

The market in North America is expected to account for largest revenue share during the forecast period. Vascular grafts use has increased as a result of the developed healthcare system and significant emphasis on innovative medical technologies in North America. In addition, the favorable insurance and payment policies in the region promote the use of vascular grafts in surgical procedures.

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Emergen Research has segmented the global vascular graft market on the basis of raw material, indication, end-use, region:

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