The patient's postoperative course was uneventful with respect to stroke or new upper extremity symptoms, however he did undergo cardioversion for atrial fibrillation with rapid ventricular response shortly after the implantation of the thoracic endograft. During follow-up there has been a steady improvement in his upper extremity brachial plexus injuries with physical therapy. There was a resolution of differential upper extremity blood pressure measurements following the procedure. Conclusions: To our knowledge, this is the first reported case of an isolated subclavian artery aneurysm associated with a right-sided aortic arch and Kommerell's diverticulum. Hybrid endovascular repair is an effective way of treating this rare complex problem.

Objectives: Atherosclerotic plaque progression within the carotid artery is thought to be due to a combination of a proinflammatory state and various hemodynamic conditions, including wall shear stresses (WSS) and vascular strain. We aimed to create a computational model of the carotid artery from carotid noninvasive imaging scans to evaluate the effects of plaque composition and artery and plaque geometry by fluid dynamics.Methods: A computational model was created from an institutional database of patients who underwent carotid endarterectomy (CEA). Patients underwent duplex ultrasonography (DUS) and computed tomography angiography (CTA) of the carotid before intervention. CTA images were evaluated in a 3D imaging software for vessel and plaque geometry; plaque composition was based on Hounsfield units (HU) from CTA scans. The geometric data were then transported into a 3D processing software (ScanIP+FE), where a patient-specific computational mesh was created. This software allowed conversion of HU into mass density based on previously validated models. This mesh was then transferred to a Multiphysics software where a model was created from the mesh. The velocity curves, obtained from preoperative DUS of the common (CCA), internal (ICA) and external (ECA) carotid artery were used to set the inlet boundaries. Outlet and pressure boundaries were created to simulate the physiologic conditions of the carotid artery. In order to evaluate velocity streamlines by time, WSS, and volumetric strain along the carotid artery, the model was subjected to dynamic fully coupled, fluid-structure time-simulation through one cardiac cycle.Results: 3D geometry analysis reveals the different mass densities in the ICA plaque (Fig, A). Time-dependent analysis of an asymptomatic patient-specific computational model demonstrated increased velocities in the stenotic portion (Fig, B) and incremental increases in WSS along the ICA lesion. The highest WSS was located at the site of the greatest plaque burden (shoulder region of the ICA ; Fig, D). Volumetric strain was found to be lowest at the site of the greatest stenosis (Fig, C), related to the highest degree of calcification, due to less deformation and higher material density of the plaque.Conclusions: Time-dependent fluid simulations from this novel model add to previously validated results from prior computational models in biomedical engineering. The benefit of a patient-specific model creation has the potential to compare changes in WSS and shear strain at various points across individual carotid plaques. In the future, computational differences between asymptomatic and acutely symptomatic patients may reveal key patientspecific features indicative of plaque vulnerability.Objectives: Drug-coated balloons have been recently approved for clinical use in the U.S. The balloons make use of a burst release, but given that many patients with peripheral arterial disease have multiple lesions, a drug-coated balloon that allows for sustained drug delivery over several minutes could be adva...