Combined radial-tibial access strategy and radial-tibial reverse CART in a patient with aortobifemoral graft and complex superficial femoral artery occlusion.

We present the case of a patient with a history of aortobifemoral grafting who presented with left lower extremity ischemic rest pain. Aortofemoral angiography was performed through a left radial access and showed a long, calcified total occlusion of the left superficial femoral artery (SFA) and a subtotal popliteal occlusion. The popliteal artery and SFA were crossed retrogradely through a 4-Fr anterior tibial access; the retrograde devices went subintimally and did not reenter at the common femoral level. Subsequently, the radial access was used for antegrade subintimal crossing and dilatation of the SFA, which allowed reentry of the retrograde devices (radial-tibial reverse controlled antegrade-retrograde tracking [CART]). The SFA was then successfully treated retrogradely with orbital atherectomy and drug-coated balloon angioplasty, through a 4-Fr equivalent tibial sheath. © 2017 Wiley Periodicals, Inc.

Combined Radial-Pedal Access Strategy and Radial-Pedal Rendezvous in the Revascularization of Complex Total Occlusions of the Superficial Femoral Artery (the "No Femoral Access" Strategy).

PURPOSE: To describe the combined use of radial-pedal access for recanalization of complex superficial femoral artery (SFA) occlusions unsuitable for transfemoral recanalization. TECHNIQUE: Patients are selected for this strategy if they have a long (≥ 10 cm) SFA occlusion with unfavorable aortoiliac anatomy, an absent ostial stump, or severely diseased and calcified distal reconstitution. Left radial artery and distal anterior or posterior tibial artery are accessed with 6-F and 4-F sheaths, respectively. The SFA lesion is crossed retrogradely with a 0.035-inch wire system. If retrograde crossing is not immediately successful, transradial subintimal tracking and radial-pedal subintimal rendezvous are used to allow retrograde reentry. Fifteen patients (mean age 62 ± 5 years; 11 men) have been treated in this fashion, and frequently stented, through the tibiopedal access. Seven patients required radial-pedal rendezvous to facilitate retrograde reentry. Two patients underwent transradial iliac stenting during the same session, and 1 patient underwent transradial kissing angioplasty of the profunda. No major complication occurred in any patient. After the procedure, the pulse across the accessed tibial artery was palpable in all patients. CONCLUSION: In patients with long and complex SFA occlusion unsuitable for transfemoral recanalization, a radial-pedal strategy can overcome revascularization obstacles.

The Chlamydomonas reinhardtii proteins Ccp1 and Ccp2 are required for long-term growth, but are not necessary for efficient photosynthesis, in a low-CO2 environment.

The unicellular green alga Chlamydomonas reinhardtii acclimates to a low-CO2 environment by modifying the expression of a number of messages. Many of the genes that increase in abundance during acclimation to low-CO2 are under the control of the putative transcription factor Cia5. C. reinhardtii mutants null for cia5 do not express several of the known low-CO2 inducible genes and do not grow in a low-CO2 environment. Two of the genes under the control of Cia5, Ccp1 and Ccp2 , encode polypeptides that are localized to the chloroplast envelope and have a high degree of similarity to members of the mitochondrial carrier family of proteins. Since their discovery, Ccp1/2 have been candidates for bicarbonate uptake proteins of the chloroplast envelope membrane. In this report, RNA interference was successful in dramatically decreasing the abundance of the mRNAs for Ccp1 and Ccp2 . The abundance of the Ccp1 and Ccp2 proteins were also reduced in the RNAi strains. The RNAi strains grew slower than WT in a low-CO2 environment, but did not exhibit a mutant carbon concentrating phenotype as determined by the cells' apparent affinity for dissolved inorganic carbon. Possible explanations of this RNAi phenotype are discussed.

Rubisco activase is required for optimal photosynthesis in the green alga Chlamydomonas reinhardtii in a low-CO(2) atmosphere.

This report describes a Chlamydomonas reinhardtii mutant that lacks Rubisco activase (Rca). Using the BleR (bleomycin resistance) gene as a positive selectable marker for nuclear transformation, an insertional mutagenesis screen was performed to select for cells that required a high-CO2 atmosphere for optimal growth. The DNA flanking the BleR insert of one of the high-CO2-requiring strains was cloned using thermal asymmetric interlaced-polymerase chain reaction and inverse polymerase chain reaction and sequenced. The flanking sequence matched the C. reinhardtii Rca cDNA sequence previously deposited in the National Center for Biotechnology Information database. The loss of a functional Rca in the strain was confirmed by the absence of Rca mRNA and protein. The open reading frame for Rca was cloned and expressed in pSL18, a C. reinhardtii expression vector conferring paromomycin resistance. This construct partially complemented the mutant phenotype, supporting the hypothesis that the loss of Rca was the reason the mutant grew poorly in a low-CO2 atmosphere. Sequencing of the C. reinhardtii Rca gene revealed that it contains 10 exons ranging in size from 18 to 470 bp. Low-CO2-grown rca1 cultures had a growth rate and maximum rate of photosynthesis 60% of wild-type cells. Results obtained from experiments on a cia5 rca1 double mutant also suggest that the CO2-concentrating mechanism partially compensates for the absence of an active Rca in the green alga C. reinhardtii.