BACKGROUND:Familial premature coronary artery disease (CAD) is often associated with genetic variants. This study investigated potential causal variants in a Chinese pedigree with premature CAD. METHODS:In total, nine family members were included in the study (six CAD patients and three unaffected controls). Whole-exome sequencing (WES) was performed on six family members (including four patients and two unaffected controls), and the candidate variant was further validated by Sanger sequencing in four individuals. RESULTS:A strong linkage between c.6406C>G (p.Gln2136Glu; NM_005751.5) in AKAP9 (A-KINASE ANCHOR PROTEIN 9; OMIM 604001) and premature CAD was detected in the pedigree. Functional analysis revealed that the c.6406C>G variant in AKAP9 decreased the interaction between AKAP9 and PRKAR2A. This association was first detected in premature CAD patients. CONCLUSIONS:Our findings indicate that c.6406C>G in the AKAP9 gene could be a causal variant for premature CAD in the Chinese population.

BACKGROUND:Transcatheter aortic valve replacement (TAVR) with wet tissue valves have several limitations that compromise their durability and lifespan, and it is technically challenging in patients with a tortuous descending aorta. CASE SUMMARY:We report an 81-year-old woman with severe symptomatic aortic stenosis, characterized by a functionally bicuspid aortic valve with extensive calcification, horizontal heart configuration. and tortuous descending aorta. The patient underwent successful transfemoral TAVR using a premounted dry valve system with cerebral embolic protection and a minimalist approach. DISCUSSION:This case confirms the feasibility of long sheath-assisted TAVR using a premounted dry valve system. Given the availability of premounted dry valves in China, the use of a premounted dry valve with potentially enhanced durability was chosen to avoid the risk of reintervention in this elderly patient. TAKE-HOME MESSAGE:Successful TAVR using a premounted dry valve system in patients with complex anatomy requires meticulous preprocedural planning, advanced imaging analysis, and appropriate device selection.

OBJECTIVES:To evaluate the feasibility, efficacy and safety of Sentinel cerebral embolic protection device (CEPD) during transcatheter aortic valve replacement (TAVR). This study is a subgroup analysis of the China Moderate to Severe Valvular Heart Disease Registry, which has been registered at the Chinese Clinical Trial Registry (ChiCTR2300075006). METHODS:Patients undergoing TAVR with the Sentinel CEPD from October 2023 to September 2024 were retrospectively enrolled. A total of 80 patients were included, with a median age of 72 (68, 76) years, including 52 males (65.0%) and 28 females (35.0%); 62 patients (77.5%) with tricuspid valves, and 18 patients (22.5%) with bicuspid valves; 34 patients (42.5%) with type Ⅰ aortic arch, 24 patients (30.0%) with type Ⅱ aortic arch, 12 patients (15.0%) with type Ⅲ aortic arch, and 10 patients (12.5%) with bovine-type aortic arch. Clinical data of the patients were summarized and analyzed. The primary endpoints were success rate of Sentinel CEPD implantation, as well as all-cause death, symptomatic stroke, transient ischemic attack, and Sentinel CEPD access vessel complications during hospitalization and within 30 days postoperatively. RESULTS:In the 80 patients, self-expanding valves were used in 68 cases (85.0%) and balloon-expandable valves in 12 cases (15.0%). Seventy-nine patients (98.8%) successfully underwent TAVR with Sentinel CEPD deployment. Macroscopically visible debris was captured in 92.5% (74/80) by filters of Sentinel CEPD. Although the procedure time for Sentinel CEPD placement was slightly longer in patients with bovine-type aortic arch, there was no statistically significant difference in deployment time among different aortic arch types (P>0.05). During hospitalization and within 30 days postoperatively, only one case of transient ischemic attack occurred, and there was no all-cause mortality, symptomatic stroke, or access-site vascular complications related to the Sentinel CEPD observed. CONCLUSIONS:The Sentinel CEPD demonstrates high feasibility across aortic arch types, potential efficacy in embolic capture, and excellent safety in TAVR.

Aims:The IVUS-ACS trial demonstrated that intravascular ultrasound (IVUS) guidance reduces target-vessel failure (TVF) in patients with acute coronary syndromes (ACSs) undergoing percutaneous coronary intervention (PCI). Whether this benefit applies to all ACS patients across the spectrum of risk is unknown. We sought to develop a new risk score for 1-year TVF after PCI in ACS and determine whether IVUS guidance compared with angiography guidance improves outcomes in both high- and low-risk patients. Methods and results:From the angiography-guided group of the IVUS-ACS trial (n = 1743), the TVF-ACS risk score was developed using the least absolute shrinkage and selection operator method in a derivation group (n = 1288), and its robustness was assessed in an internal validation group (n = 455). External validation was then performed separately in the IVUS-XPL and ULTIMATE trials. Outcomes in high- and low-risk patients randomized to IVUS guidance vs. angiography guidance were then examined. Ten readily available clinical, laboratory, and angiographic variables were selected for inclusion in the TVF-ACS risk score. A cut-off value of 15.64 discriminated angiography-guided PCI patients at high-risk vs. low risk [area under the curve (AUC) 0.715, 95% confidence interval (CI) 0.653-0.777]. The AUC was similar in the validation group [0.709 (95% CI 0.630-0.788)]. High-risk patients exhibited a higher 1-year rate of TVF compared with low-risk patients [19.8 vs. 5.7%, hazard ratio (HR) 3.81, 95% CI 2.06-7.02, P = 0.00002]. Among 3486 randomized patients, IVUS guidance compared with angiography guidance reduced 1-year TVF in high-risk patients (6.9 vs. 17.6%; HR 0.38, 95% CI 0.24-0.59) with a lesser effect in low-risk patients (3.2 vs. 4.3%; HR 0.75, 95% CI 0.51-1.11; P interaction = 0.02). External validation in the IVUS-XPL and ULTIMATE trials confirmed these benefits but with consistent effects in high- and low-risk patients (P interactions = 0.49 and 0.92, respectively). Conclusion:The TVF-ACS risk score reliably stratifies ACS patients undergoing PCI into high- and low-risk groups. The benefits of IVUS guidance during PCI are most pronounced in high-risk ACS patients, although all ACS patients are likely to benefit.

BACKGROUND:Annular measurements traditionally guide transcatheter heart valve sizing in transcatheter aortic valve replacement (TAVR). Although supra-annular assessment has emerged as a crucial consideration, particularly in bicuspid aortic valve (BAV) cases, current measurement methods lack standardization and reproducibility. OBJECTIVES:The aim of this study was to develop and validate a standardized multiplanar approach for transcatheter heart valve sizing integrating both annular and supra-annular measurements. METHODS:This retrospective study included 377 patients (191 with BAVs, 186 with tricuspid aortic valves [TAVs]) who underwent TAVR with the Venus A-Valve. The multiplanar protocol used measurements at 2-mm intervals above the annulus, incorporating both commissural and leaflet margin assessments. A subset of 54 patients underwent detailed postprocedural morphologic and biomechanical analyses. Clinical outcomes were compared with a propensity-matched cohort (n = 98 pairs) from the VENUS-A study using traditional annulus-based sizing. RESULTS:The multiplanar strategy resulted in downsizing for 89.0% of BAV patients (170 of 191) and 64.5% of TAV patients (120 of 186) compared with annulus-based sizing. There were no significant differences between downsized and nondownsized cases in both the TAV and BAV groups. Postoperative analyses showed strong correlations between preprocedural measurements and postimplantation valve morphology and biomechanics. The multiplanar strategy group had a lower incidence of valve-in-valve procedures compared with the annulus-based group (3.1% vs 12.2%; P = 0.032; OR: 3.9; 95% CI: 1.206-16.186). CONCLUSIONS:Multiplanar supra-annular measurement provides a comprehensive evaluation of aortic root anatomy, enabling more precise TAVR sizing for both BAV and TAV patients.

Iron is considered as an attractive alternative material for bioresorbable scaffolds (BRS). The sirolimus eluting iron bioresorbable scaffold (IBS), developed by Biotyx Medical (Shenzhen, China), is the only iron-based BRS with an ultrathin-wall design. The study aims to investigate the long-term efficacy, safety, biocompatibility, and lumen changes during the biodegradation process of the IBS in a porcine model. A total of 90 IBSs and 70 cobalt-chromium everolimus eluting stents (EES) were randomly implanted into nonatherosclerotic coronary artery of healthy mini swine. The multimodality assessments including coronary angiography, optical coherence tomography, micro-computed tomography, magnetic resonance imaging, real-time polymerase chain reaction (PCR), and histopathological evaluations, were performed at different time points. There was no statistical difference in area stenosis between IBS group and EES group at 6 months, 1year, 2 years and 5 years. Although the scaffolded vessels narrowed at 9 months, expansive remodeling with increased mean lumen area was found at 3 and 5 years. The IBS struts remained intact at 6 months, and the corrosion was detectable at 9 months. At 5 years, the iron struts were completely degraded and absorbed in situ, without in-scaffold restenosis or thrombosis, lumen collapse, aneurysm formation, and chronic inflammation. No local or systemic toxicity and abnormal histopathologic manifestation were found in all experiments. Results from real-time PCR indicated that no sign of iron overload was reported in scaffolded segments. Therefore, the IBS shows comparable efficacy, safety, and biocompatibility with EES, and late lumen enlargement is considered as a unique feature in the IBS-implanted vessels.

Background:Membranous interventricular septum aneurysm (MISA) is a rare abnormality occurring in 0.3% of patients with congenital heart disease, which thereby increases anatomical complexity. Case summary:Transcatheter aortic valve replacement (TAVR) procedure was planned for a 71-year-old female patient from East Asia with a type 1 bicuspid aortic valve diagnosed with severe aortic stenosis by transthoracic echocardiography (TTE). Pre-procedural multidetector computed tomography (MDCT) clearly revealed an extremely horizontal aorta and a MISA originating from the sub-annulus with the upper edge extending 7.2 mm above the annulus. A probable communicating flow between the left ventricle and the aorta was confirmed by reviewing the TTE images. Moreover, there was a calcified raphe between the left- and right-coronary cusps. A downsized balloon-expandable valve (a 23 mm Sapien 3 valve with an additional 2 mL dilation) was therefore chosen and deployed with a 100/0 aortic/ventricular ratio position. The TTE post-implantation indicated a trace perivalvular leakage. The cardiac MDCT performed post-procedure, at the 6-month, and 12-month follow-ups demonstrated complete sealing and significant healing of the aneurysm. Discussion:Transcatheter aortic valve replacement utilizing a balloon-expandable valve was successfully performed for a case with membranous interventricular septum aneurysm extending above the annulus. Comprehensive imaging analysis before the procedure is crucial for TAVR with challenging anatomical conditions.

Transcatheter aortic valve replacement (TAVR) procedure was planned for a 68-year-old female patient diagnosed with severe aortic stenosis by transthoracic echocardiography. The first valve unexpectedly dislodged during catheter tip withdrawal after full deployment. A second valve deployment became necessary, posing challenges due to the difficulty of passing the second valve delivery system through the first valve frame. The snare technique is typically used in cases where there are difficulties in delivering the transcatheter heart valve system across the native aortic valve during the TAVR procedure. We described a novel bailout technique to capture the delivery system in the main access using a snare catheter from the secondary access, while retaining the stiff wire in the left ventricle. This technique could be particularly applicable in scenarios where recrossing is challenging and risky.

Background The CYP2C19 loss-of-function variants have significant impact on response to clopidogrel. The efficacy and safety of tailored antiplatelet therapy under the guidance of CYP2C19 genetic polymorphisms remains elusive for patients undergoing percutaneous coronary intervention (PCI). Objectives The aims of the present study were to investigate the impact of clinical implementation of CYP2C19 genotyping on the selection of oral P2Y12 inhibitor therapy following PCI, and to estimate the risk of adverse outcomes for patients with different genotype status treated with alternative or traditional P2Y12 inhibitor. Methods Data from a single-center registry enrolling 41,090 consecutive PCI patients treated with dual antiplatelet therapy after PCI were analyzed. Risk of major adverse cardiovascular events (MACEs) and bleeding events within 12 months after PCI were compared across CYP2C19 genotype and antiplatelet therapy groups using Cox proportional hazards models. Results CYP2C19 genotyping was successfully achieved for 9081 patients, of whom baseline characteristics significantly differed from non-genotyped patients. A higher proportion of genotyped patients were prescribed ticagrelor compared with non-genotyped patients (27.0 % vs. 15.5 %, P < 0.001). CYP2C19 metabolic status was an independent predictor for use of ticagrelor (P < 0.001). Ticagrelor was significantly associated with a lower risk of MACEs in poor metabolizers (adjusted hazard ratio 0.62, 95 % confidence interval 0.42 to 0.92, P = 0.017), but not in intermediate metabolizers or normal metabolizers. The interaction was not statistically significant (P for interaction = 0.252). Conclusions Genotype information on CYP2C19 metabolic status was associated with an increase in the use of potent antiplatelet therapy in PCI patients. Patients prescribed with clopidogrel has a higher risk of MACEs among poor metabolizers, which suggested the potential application of genotype-guided P2Y12 inhibitor selection for improving clinical outcomes.

目的 比较替格瑞洛和氯吡格雷在接受经皮冠状动脉介入治疗(PCI)的非ST段抬高型急性冠状动脉综合征(NSTE-ACS)患者中的有效性和安全性.方法 单中心、回顾性研究.连续纳入 2018 年 1 月至 2018 年 12 月接受PCI治疗的NSTE-ACS患者 7417 例.所有患者均接受双联抗血小板治疗(DAPT),将患者分为替格瑞洛组(1665 例)和氯吡格雷组(5752 例).随访比较两组患者的主要不良心脑血管事件(MACCEs)和心肌梗死溶栓(TIMI)出血事件的发生风险.结果 经过倾向性评分匹配分析后,替格瑞洛组的MACCEs发生率显著低于氯吡格雷组(4.9%比 6.5%,HR= 0.71,95%CI:0.50～0.97,P=0.043).其中,全因死亡、心原性死亡和再次血运重建的发生率低于氯吡格雷组(均为P<0.05).替格瑞洛组的TIMI总体出血事件发生率显著高于氯吡格雷组(6.7%比4.7%,HR=1.84,95%CI:1.28～2.50,P=0.017).结论 在接受PCI治疗的NSTE-ACS患者中,与氯吡格雷相比,替格瑞洛可降低MACCEs的发生风险,但增加小出血风险.

The clinical relevance of coronary artery ectasia (CAE) is poorly understood. We investigated the prevalence, potential predictors, and prognostic significance of CAE in patients with atherosclerotic coronary artery disease. Consecutive patients undergoing percutaneous coronary intervention (PCI) from January 2016 to December 2018 were included and followed up for 1 year. CAE was diagnosed as an abnormal dilation >1.5-fold the diameter of adjacent normal segments on angiography. A total of 590 patients with CAE were identified from 36 790 patients undergoing PCI (overall rate of CAE: 1.6%). In multivariate analysis, variables including body mass index >30 kg/m2 (risk ratio, RR: 2.413, P = .018), ever-smoking (RR: 1.669, P < .001), hypertension (RR: 1.221, P = .025), acute myocardial infarction at admission (RR: 1.343, P = .004), no diabetes (RR: .810, P = .023), previous myocardial infarction (RR: 1.545, P < .001), no left main disease (RR: .632, P = .008) and multiple-vessel disease (RR: 1.326, P = .001), increased C-reactive protein (RR: 1.006, P = .012) were predictors of CAE. The incidence of adverse cardiovascular outcomes did not differ significantly between patients with or without CAE ( P = .203). CAE is not uncommon among patients undergoing PCI in this cohort study. The presence of CAE vs its absence had no significant impact on 1-year clinical outcomes after PCI.

Objectives To assess the effect of sex differences on short-term and long-term mortality among patients with ST-segment elevation myocardial infarction (STEMI). Design Systematic review and meta-analysis of contemporary available evidence. Setting PubMed, Embase and Cochrane Library were searched for relevant studies reporting sex-specific outcomes among patients with STEMI published between 1 January 2010 and 1 August 2020. Risk ratios (RRs) and 95% CIs were measured using DerSimonian and Laird random-effects model. Sensitivity analyses were performed and publication bias was also checked. All statistical analyses were performed using STATA V.15.0. Participants Studies providing data about short-term or long-term mortality stratified by sex in patients with STEMI were included. Only study conducted in last 10 years were included. Primary and secondary outcome measures The primary outcome was all-cause death at short-term (in-hospital or 30 days) and long-term (at least 12 months) follow-up. Results A total of 15 studies involving 128 585 patients (31 706 (24.7%) female and 96 879 (75.3%) male) were included. In the unadjusted analyses, female were at a higher risk of short-term mortality (RR, 1.73; 95% CI 1.53 to 1.96, p<0.001, I-2=77%) but not long-term mortality (RR, 1.23; 95% CI 0.89 to 1.69, p=0.206, I-2=77.5%). When adjusted effect estimates from individual studies were used in meta-analysis, the association between female and higher risk of short-term mortality remained significant (RR, 1.24; 95% CI 1.11 to 1.38, p<0.001, I-2=39.6%). And adjusted long-term mortality was also similar between female and male (RR, 1.11; 95% CI 0.42 to 1.80, p=0.670, I-2=74.5%). Conclusions An increased short-term but not long-term mortality was found in female with STEMI. After adjustment for baseline cardiovascular risk factors and clinical profiles, short-term mortality remains higher in female with STEMI compared with male, indicating the need for further improvements in management in female patients.

This study aimed to investigate the long-term biocompatibility, safety, and degradation of the ultrathin nitrided iron bioresorbable scaffold (BRS) in vivo, encompassing the whole process of bioresorption in porcine coronary arteries. Fifty-two nitrided iron scaffolds (strut thickness of 70 mu m) and 28 Vision Co-Cr stents were randomly implanted into coronary arteries of healthy mini-swine. The efficacy and safety of the nitrided iron scaffold were comparable with those of the Vision stentwithin 52 weeks after implantation. In addition, the long-term biocompatibility, safety, and bioresorption of the nitrided iron scaffold were evaluated by coronary angiography, optical coherence tomography, micro-computed tomography, scanning electron microscopy, energy dispersive spectrometry and histopathological evaluations at 4, 12, 26, 52 weeks and even at 7 years after implantation. In particular, a large number of struts were almost completely absorbed in situ at 7 years follow-up, which were first illustrated in this study. The lymphatic drainage pathway might serve as the potential clearance way of iron and its corrosion products.

Background: The remnant-like particle cholesterol (RLP-C) has been demonstrated to be associated with residual cardiovascular risk. The meta-analysis aimed to evaluate the impact of baseline RLP-C on the incidence of major cardiovascular adverse events (MACEs) in patients with coronary artery disease (CAD). Methods: A systematic literature search was performed in PubMed and Embase electronic databases from the inception of the databases through 1 October 2022. Studies evaluating the association between baseline RLP-C and the risk of MACEs in patients with CAD were included. Hazard ratios (HRs) with 95% confidence intervals (CIs) were pooled by a random-effect method (RLP-C analyzed as a categorical variable) and a fixed-effects model (RLP-C analyzed as a continuous variable). Results: Ten studies including 18,053 subjects were finally included in this meta-analysis. In our pooled analysis, compared to CAD patients with the lowest RLP-C category, the CAD patients with the highest RLP-C category had a significantly higher risk of future MACEs during follow-up (HR 1.79, 95% CI, 1.42–2.26, I2 = 60.31%, p < 0.01), which was consistent with outcomes of meta-analysis with the RLP-C analyzed as a continuous variable (HR 1.40, 95% CI, 1.28–1.53, I2 = 38.20%, p < 0.01). The sensitivity analysis confirmed the robustness of the results, and no significant publication bias was identified. Conclusion: The present meta-analysis suggests that the RLP-C was associated with an increased risk of long-term MACEs in patients with CAD at baseline. It is necessary to conduct randomized controlled trials to explore whether reducing the RLP-C level is conducive to reducing residual cardiovascular risk, even coronary plaque regression.

In patients with diabetes, the Wnt/β-catenin pathway in vascular smooth muscle cells (VSMCs) is continuously activated by low-intensity inflammation, which leads to the osteoblastic differentiation of these cells and the deposition of calcium and phosphorus in blood vessels. The aim of the present study was to determine whether long intergenic non-coding RNA-erythroid pro-survival (lincRNA-EPS) was able to ameliorate vascular calcification (VC) associated with diabetes. VSMCs isolated from C57BL/6 mice were transfected with lincRNA-EPS overexpression vector in vitro and their osteoblastic differentiation was evaluated under high-glucose conditions. In addition, a mouse model of diabetes was established, which included a lincRNA-EPS knockout group and a lincRNA-EPS high expression group. Blood vessel samples from the mice were examined to determine the degree of calcification. The levels of inflammatory factors in serum were also detected. The VSMCs transfected with lincRNA-EPS overexpression vector exhibited less osteoblastic differentiation and migration and significantly lower levels of Wnt pathway-associated proteins than those transfected with empty control. Furthermore, the in vivo experiments revealed that the overexpression of lincRNA-EPS significantly reduced VC in diabetic mice. Therefore, on the basis of these findings, it is suggested that lincRNA-EPS overexpression may provide a novel and effective method for the treatment of VC in patients with diabetes.

It is unclear whether or not nonalcoholic fatty liver disease (NAFLD)/metabolic dysfunction–associated fatty liver disease (MAFLD) is related to short sleep duration. A meta-analysis was conducted to determine if inadequate sleep time increased the risk of NAFLD/MAFLD. A comprehensive systematic literature review was conducted in the Embase, PubMed, and Cochrane Library databases from inception to August 1, 2022. Studies examining the correlation between inadequate sleep time and the risk of NAFLD/MAFLD were included. We pooled the odds ratios (ORs) and 95

Abstract The benefits of potent antithrombotic therapy usually come at the expense of a higher risk of bleeding. The efficacy and safety of ticagrelor in elderly East Asian populations remains debated due to the concerns about the imbalance of ischemic and bleeding risks. This study aimed to compare the impact of clopidogrel with ticagrelor on clinical outcomes in East Asian patients aged ≥75 years with acute coronary syndrome (ACS) using data from an institutional registry. We assessed the treatment effect of ticagrelor versus clopidogrel based on propensity scores and multivariate Cox proportional hazards models. A total of 2775 ACS patients were included, of which 235 (8.5%) were treated with ticagrelor. The primary efficacy outcome occurred in 11.9% of patients treated with ticagrelor versus 8.8% treated with clopidogrel. There was no significant association between treatment with ticagrelor and a lower risk of the primary efficacy outcome (p = .156). However, the incidences of all-cause death (hazard ratio [HR] 1.69, 95% confidence interval [CI] 1.02 to 2.79) and major bleeding (adjusted HR 2.20, 95% CI 1.06 to 4.56) were significantly higher in patients treated with ticagrelor than clopidogrel. In elderly patients with ACS from East Asia, the efficacy of clopidogrel was comparable to ticagrelor, while ticagrelor is associated with an increased risk of mortality and major bleeding. Plain Language Summary What is the context? Current guidelines recommend ticagrelor over clopidogrel for patients with acute coronary syndrome (ACS). There are no specific guidelines concerning the elderly, and data on optimal antiplatelet therapy in elderly are quite scarce. Further study was necessary to identify the efficacy and safety of ticagrelor and clopidogrel in elderly patients from East Asian populations which are reported to be at a higher risk of bleeding. What is new? The risk of major adverse cardiac events did not differ significantly between clopidogrel versus ticagrelor in patients aged ≥75 years from East Asia, while the use of ticagrelor might be associated with increased risk of mortality and major bleeding events. Analyses after propensity score matching showed consistent results on the safety and efficacy of clopidogrel versus ticagrelor. The benefit of potent P2Y12 inhibitor ticagrelor over clopidogrel is questionable in elderly East Asian patients with ACS. What is the impact? This study provides more information on the use of potent antiplatelet therapy in older patients from Asia. The individual assessment of ischemic and bleeding risk is necessary to guide decision-making on DAPT rather than applying the recommendations of guidelines directly.

Small-diameter tissue-engineered vascular grafts (sdTEVGs) with hyperglycemia resistance have not been constructed. The intimal hyperplasia caused by hyperglycemia remains problem to hinder the patency of sdTEVGs. Here, inspired by bionic regulation of nerve on vascular, we found the released neural exosomes could inhibit the abnormal phenotype transformation of vascular smooth muscle cells (VSMCs). The transformation was a prime culprit causing the intimal hyperplasia of sdTEVGs. To address this concern, sdTEVGs were modified with an on-demand programmable dual-responsive system of ultrathin hydrogels. An external primary Reactive Oxygen Species (ROS)-responsive Netrin-1 system was initially triggered by local inflammation to induce nerve remolding of the sdTEVGs overcoming the difficulty of nerve regeneration under hyperglycemia. Then, the internal secondary ATP-responsive DENND1A (guanine nucleotide exchange factor) system was turned on by the neurotransmitter ATP from the immigrated nerve fibers to stimulate effective release of neural exosomes. The results showed nerve fibers grow into the sdTEVGs in diabetic rats 30 days after transplantation. At day 90, the abnormal VSMCs phenotype was not detected in the sdTEVGs, which maintained long-time patency without intima hyperplasia. Our study provides new insights to construct vascular grafts resisting hyperglycemia damage.