CORONARY ENDARTERECTOMY AND PATCH ANGIOPLASTY FOR DIFFUSE CORONARY ARTERY DISEASE. A PROSPECTIVE ANALYSIS OF 22 CASES

• Main Authors: Shkar Saed, Hisham Hasan, Abdulsalam Taha
• Format: Article
• Language: English
• Published: university of basrah 2019-12-01
• Series: Basrah Journal of Surgery
• Subjects: coronary artery disease; endarterectomy; angioplasty; venous; patch; left anterior descending; left internal mammary artery
• Online Access: https://bjsrg.uobasrah.edu.iq/article_164514_9fb769ee1c61c8edf9f1fc327219af44.pdf

<span style="font-size: 10.0pt; line-height: 99%; font-family: 'Arial','sans-serif'; letter-spacing: -.05pt;">Diffus</span><span style="font-size: 10.0pt; line-height: 99%; font-family: 'Arial','sans-serif';">e<span style="letter-spacing: -.05pt;">cor</span><span style="letter-spacing: -.2pt;">o</span><span style="letter-spacing: -.15pt;">n</span><span style="letter-spacing: -.05pt;">ar</span>y<span style="letter-spacing: -.05pt;">art</span><span style="letter-spacing: -.15pt;">e</span><span style="letter-spacing: -.05pt;">r</span>y<span style="letter-spacing: -.1pt;">d</span><span style="letter-spacing: -.15pt;">i</span><span style="letter-spacing: -.1pt;">s</span><span style="letter-spacing: -.05pt;">e</span><span style="letter-spacing: -.15pt;">a</span>se<span style="letter-spacing: -.05pt;">(C</span><span style="letter-spacing: -.15pt;">A</span><span style="letter-spacing: -.05pt;">D</span>)<span style="letter-spacing: -.15pt;">i</span>sa<span style="letter-spacing: -.05pt;">s</span><span style="letter-spacing: .1pt;">u</span>rg<span style="letter-spacing: -.15pt;">i</span><span style="letter-spacing: -.05pt;">c</span>alcha<span style="letter-spacing: -.05pt;">ll</span><span style="letter-spacing: -.2pt;">e</span>nge<span style="letter-spacing: -.1pt;">i</span>nwh<span style="letter-spacing: -.1pt;">i</span>chc<span style="letter-spacing: -.1pt;">o</span>nv<span style="letter-spacing: -.15pt;">e</span>ntionalc<span style="letter-spacing: -.1pt;">o</span>ro<span style="letter-spacing: -.2pt;">n</span>ary <span style="letter-spacing: -.1pt;">a</span><span style="letter-spacing: -.05pt;">r</span><span style="letter-spacing: -.1pt;">te</span><span style="letter-spacing: -.05pt;">r</span>y<span style="letter-spacing: -.1pt;">by</span><span style="letter-spacing: -.15pt;">p</span><span style="letter-spacing: -.05pt;">as</span>s<span style="letter-spacing: -.1pt;">g</span><span style="letter-spacing: -.05pt;">r</span><span style="letter-spacing: -.1pt;">aftin</span>g<span style="letter-spacing: -.05pt;">(C</span><span style="letter-spacing: -.15pt;">A</span><span style="letter-spacing: -.1pt;">BG</span>)<span style="letter-spacing: -.1pt;">ma</span>y<span style="letter-spacing: -.15pt;">n</span>ot<span style="letter-spacing: -.1pt;">a</span><span style="letter-spacing: -.05pt;">c</span><span style="letter-spacing: -.1pt;">h</span><span style="letter-spacing: -.15pt;">i</span><span style="letter-spacing: -.1pt;">ev</span>e<span style="letter-spacing: -.05pt;">a</span><span style="letter-spacing: -.15pt;">de</span><span style="letter-spacing: -.05pt;">quat</span>e<span style="letter-spacing: -.05pt;">my</span><span style="letter-spacing: -.2pt;">o</span>c<span style="letter-spacing: -.2pt;">a</span>r<span style="letter-spacing: -.05pt;">d</span>ial<span style="letter-spacing: -.05pt;">r</span>ev<span style="letter-spacing: -.15pt;">a</span><span style="letter-spacing: -.05pt;">s</span>cu<span style="letter-spacing: -.2pt;">l</span>arization<span style="letter-spacing: -.2pt;">u</span>nl<span style="letter-spacing: -.2pt;">e</span>ss adjuvant<span style="letter-spacing: -.2pt;">p</span>r<span style="letter-spacing: -.15pt;">o</span><span style="letter-spacing: -.1pt;">c</span>edures<span style="letter-spacing: -.05pt;">s</span>uchasc<span style="letter-spacing: -.15pt;">o</span><span style="letter-spacing: -.05pt;">r</span>o<span style="letter-spacing: -.15pt;">n</span>aryend<span style="letter-spacing: -.15pt;">a</span>rt<span style="letter-spacing: -.1pt;">ere</span><span style="letter-spacing: -.05pt;">c</span><span style="letter-spacing: -.1pt;">t</span><span style="letter-spacing: -.2pt;">o</span><span style="letter-spacing: -.1pt;">m</span>y<span style="letter-spacing: -.1pt;">an</span>d<span style="letter-spacing: -.05pt;">c</span><span style="letter-spacing: -.2pt;">o</span><span style="letter-spacing: -.05pt;">r</span><span style="letter-spacing: -.15pt;">o</span><span style="letter-spacing: -.1pt;">na</span><span style="letter-spacing: -.05pt;">r</span>y<span style="letter-spacing: -.15pt;">p</span>a<span style="letter-spacing: -.1pt;">tc</span>h<span style="letter-spacing: -.2pt;">a</span><span style="letter-spacing: -.1pt;">ngiop</span><span style="letter-spacing: -.15pt;">l</span><span style="letter-spacing: -.1pt;">ast</span>y<span style="letter-spacing: -.05pt;">(</span><span style="letter-spacing: -.1pt;">CPA) </span><span style="letter-spacing: -.05pt;">ar</span>e<span style="letter-spacing: -.1pt;">a</span>d<span style="letter-spacing: -.15pt;">d</span><span style="letter-spacing: -.05pt;">ed</span>.<span style="letter-spacing: -.2pt;">T</span><span style="letter-spacing: -.05pt;">h</span>e<span style="letter-spacing: -.05pt;">ai</span>m<span style="letter-spacing: -.05pt;">o</span>f<span style="letter-spacing: -.05pt;">thi</span>s<span style="letter-spacing: -.05pt;">pr</span><span style="letter-spacing: -.2pt;">o</span>s<span style="letter-spacing: -.15pt;">p</span>e<span style="letter-spacing: -.05pt;">c</span><span style="letter-spacing: -.1pt;">tiv</span>e<span style="letter-spacing: -.05pt;">s</span><span style="letter-spacing: -.1pt;">tud</span>y<span style="letter-spacing: -.1pt;">i</span>s<span style="letter-spacing: -.1pt;">t</span>o<span style="letter-spacing: -.1pt;">e</span><span style="letter-spacing: -.15pt;">v</span><span style="letter-spacing: -.1pt;">aluat</span>e<span style="letter-spacing: -.1pt;">th</span>e<span style="letter-spacing: -.05pt;">o</span><span style="letter-spacing: -.15pt;">u</span><span style="letter-spacing: -.1pt;">t</span><span style="letter-spacing: -.05pt;">com</span>e<span style="letter-spacing: -.05pt;">o</span>f<span style="letter-spacing: -.05pt;">thes</span>e<span style="letter-spacing: -.05pt;">pr</span><span style="letter-spacing: -.15pt;">o</span><span style="letter-spacing: -.05pt;">ced</span><span style="letter-spacing: -.15pt;">u</span><span style="letter-spacing: -.05pt;">r</span><span style="letter-spacing: -.2pt;">e</span>s<span style="letter-spacing: -.05pt;">in </span><span style="letter-spacing: -.1pt;">ou</span>r<span style="letter-spacing: -.1pt;">i</span><span style="letter-spacing: -.15pt;">n</span><span style="letter-spacing: -.05pt;">s</span><span style="letter-spacing: -.1pt;">titutio</span>n<span style="letter-spacing: -.1pt;"> i</span>n<span style="letter-spacing: -.1pt;"> vie</span>w<span style="letter-spacing: -.1pt;">o</span>f<span style="letter-spacing: -.1pt;">th</span>e <span style="letter-spacing: -.1pt;">relevan</span>t<span style="letter-spacing: -.1pt;">literature.</span></span> <span style="font-size: 10.0pt; line-height: 99%; font-family: 'Arial','sans-serif'; letter-spacing: -.05pt;">D</span><span style="font-size: 10.0pt; line-height: 99%; font-family: 'Arial','sans-serif'; letter-spacing: -.1pt;">at</span><span style="font-size: 10.0pt; line-height: 99%; font-family: 'Arial','sans-serif';">a<span style="letter-spacing: -.1pt;">o</span>f<span style="letter-spacing: -.1pt;">al</span>l<span style="letter-spacing: -.1pt;">patient</span>s<span style="letter-spacing: -.05pt;">w</span><span style="letter-spacing: -.15pt;">h</span>o<span style="letter-spacing: -.1pt;">un</span><span style="letter-spacing: -.15pt;">d</span><span style="letter-spacing: -.1pt;">er</span><span style="letter-spacing: -.05pt;">w</span><span style="letter-spacing: -.1pt;">en</span>t<span style="letter-spacing: -.05pt;">C</span><span style="letter-spacing: -.1pt;">PA</span><span style="letter-spacing: -.05pt;">±C</span><span style="letter-spacing: -.1pt;">A</span><span style="letter-spacing: -.15pt;">B</span>Gby<span style="letter-spacing: -.05pt;">on</span>es<span style="letter-spacing: -.1pt;">u</span>r<span style="letter-spacing: -.2pt;">g</span><span style="letter-spacing: -.05pt;">eo</span>n<span style="letter-spacing: -.15pt;">i</span>n<span style="letter-spacing: -.1pt;">o</span>ur<span style="letter-spacing: -.2pt;">i</span>nstitution  (<span style="letter-spacing: -.15pt;">n</span>=22) betw<span style="letter-spacing: -.15pt;">e</span><span style="letter-spacing: -.1pt;">e</span>n<span style="letter-spacing: -.05pt;">A</span><span style="letter-spacing: -.15pt;">p</span><span style="letter-spacing: -.05pt;">r</span>il2018a<span style="letter-spacing: -.15pt;">n</span>d<span style="letter-spacing: -.05pt;">A</span>pril<span style="letter-spacing: -.15pt;">2</span>019w<span style="letter-spacing: -.2pt;">e</span>recol<span style="letter-spacing: -.15pt;">l</span><span style="letter-spacing: -.2pt;">e</span><span style="letter-spacing: -.05pt;">c</span>ted.<span style="letter-spacing: -.05pt;">P</span>atien<span style="letter-spacing: -.15pt;">t</span>s<span style="letter-spacing: -.15pt;">u</span>nd<span style="letter-spacing: -.1pt;">e</span>rwentop<span style="letter-spacing: -.15pt;">e</span>nc<span style="letter-spacing: -.1pt;">o</span>r<span style="letter-spacing: -.15pt;">o</span>n<span style="letter-spacing: -.1pt;">a</span>ry <span style="letter-spacing: -.1pt;">end</span><span style="letter-spacing: -.15pt;">a</span><span style="letter-spacing: -.1pt;">rterect</span><span style="letter-spacing: -.2pt;">o</span><span style="letter-spacing: -.1pt;">m</span>y<span style="letter-spacing: -.1pt;">an</span>d<span style="letter-spacing: -.1pt;">on</span><span style="letter-spacing: -.15pt;">l</span><span style="letter-spacing: -.1pt;">a</span>y<span style="letter-spacing: -.1pt;">patc</span>h<span style="letter-spacing: -.1pt;">o</span>f<span style="letter-spacing: -.1pt;">lef</span>t<span style="letter-spacing: -.05pt;">i</span><span style="letter-spacing: -.1pt;">nterna</span>l<span style="letter-spacing: -.1pt;">m</span>a<span style="letter-spacing: -.2pt;">m</span><span style="letter-spacing: -.1pt;">m</span>aryar<span style="letter-spacing: -.05pt;">t</span><span style="letter-spacing: -.15pt;">e</span>ry(LIMA)orav<span style="letter-spacing: -.15pt;">e</span>no<span style="letter-spacing: -.15pt;">u</span>spa<span style="letter-spacing: -.25pt;">t</span>ch<span style="letter-spacing: -.15pt;">u</span>nder <span style="letter-spacing: -.1pt;">cardio</span><span style="letter-spacing: -.15pt;">p</span>u<span style="letter-spacing: -.1pt;">lmo</span><span style="letter-spacing: -.2pt;">n</span><span style="letter-spacing: -.1pt;">ar</span>y<span style="letter-spacing: -.1pt;">bypas</span>s<span style="letter-spacing: -.1pt;">(CPB).</span></span> <span style="font-size: 10.0pt; font-family: 'Arial','sans-serif'; letter-spacing: -.1pt;">O</span><span style="font-size: 10.0pt; font-family: 'Arial','sans-serif';">f<span style="letter-spacing: -.1pt;">16</span>7<span style="letter-spacing: -.05pt;">C</span><span style="letter-spacing: -.1pt;">A</span><span style="letter-spacing: -.15pt;">B</span>G<span style="letter-spacing: -.1pt;">pr</span><span style="letter-spacing: -.15pt;">o</span>c<span style="letter-spacing: -.15pt;">ed</span><span style="letter-spacing: -.1pt;">ur</span><span style="letter-spacing: -.2pt;">e</span>s,<span style="letter-spacing: -.1pt;">2</span>2<span style="letter-spacing: -.1pt;">wer</span>e<span style="letter-spacing: -.1pt;">combin</span><span style="letter-spacing: -.15pt;">e</span>d<span style="letter-spacing: -.1pt;">wit</span>h<span style="letter-spacing: -.05pt;">C</span><span style="letter-spacing: -.1pt;">PA</span>.<span style="letter-spacing: -.1pt;">Ther</span>e<span style="letter-spacing: -.1pt;">wer</span>e15<span style="letter-spacing: -.1pt;">(6</span><span style="letter-spacing: -.15pt;">8.</span><span style="letter-spacing: -.1pt;">2%</span>)<span style="letter-spacing: -.1pt;">mal</span><span style="letter-spacing: -.15pt;">e</span><span style="letter-spacing: -.1pt;">s</span>.<span style="letter-spacing: -.1pt;">Age </span>ran<span style="letter-spacing: -.15pt;">g</span><span style="letter-spacing: -.1pt;">e</span>d<span style="letter-spacing: -.15pt;">b</span>etween<span style="letter-spacing: -.15pt;">4</span><span style="letter-spacing: -.1pt;">3</span>-<span style="letter-spacing: -.15pt;">7</span>2yearswitha<span style="letter-spacing: -.05pt;">m</span>eanof<span style="letter-spacing: -.15pt;">5</span>9.patients<span style="letter-spacing: -.15pt;">i</span><span style="letter-spacing: -.1pt;">n</span>c<span style="letter-spacing: -.2pt;">l</span>uded<span style="letter-spacing: -.1pt;">1</span>9<span style="letter-spacing: -.15pt;">i</span>s<span style="letter-spacing: -.05pt;">o</span><span style="letter-spacing: -.2pt;">l</span><span style="letter-spacing: -.05pt;">ate</span>d<span style="letter-spacing: -.05pt;">lef</span>t<span style="letter-spacing: -.05pt;">an</span><span style="letter-spacing: -.15pt;">t</span><span style="letter-spacing: -.05pt;">eri</span><span style="letter-spacing: -.15pt;">o</span>r desc<span style="letter-spacing: -.15pt;">e</span><span style="letter-spacing: -.1pt;">n</span>ding<span style="letter-spacing: -.2pt;">a</span>rteri<span style="letter-spacing: -.2pt;">e</span>s(L<span style="letter-spacing: -.15pt;">A</span>Ds),<span style="letter-spacing: -.05pt;">t</span>wori<span style="letter-spacing: -.2pt;">g</span>ht<span style="letter-spacing: -.05pt;">c</span>oro<span style="letter-spacing: -.15pt;">n</span><span style="letter-spacing: -.1pt;">a</span>ry<span style="letter-spacing: -.1pt;">a</span>rt<span style="letter-spacing: -.15pt;">e</span>r<span style="letter-spacing: -.2pt;">i</span>esando<span style="letter-spacing: -.15pt;">n</span>e<span style="letter-spacing: -.15pt;">o</span><span style="letter-spacing: -.05pt;">btus</span>e<span style="letter-spacing: -.05pt;">m</span><span style="letter-spacing: -.15pt;">a</span><span style="letter-spacing: -.05pt;">rg</span><span style="letter-spacing: -.1pt;">i</span><span style="letter-spacing: -.15pt;">n</span><span style="letter-spacing: -.05pt;">a</span>lb<span style="letter-spacing: -.05pt;">ra</span><span style="letter-spacing: -.2pt;">n</span>c<span style="letter-spacing: -.05pt;">h</span>.<span style="letter-spacing: -.15pt;">Th</span>e CPBtime<span style="letter-spacing: -.05pt;">w</span>as8<span style="letter-spacing: -.2pt;">8</span>-1<span style="letter-spacing: -.15pt;">9</span>8<span style="letter-spacing: -.1pt;">m</span><span style="letter-spacing: -.05pt;">i</span>nutesa<span style="letter-spacing: -.15pt;">n</span>d<span style="letter-spacing: -.05pt;">t</span>hea<span style="letter-spacing: -.1pt;">o</span>rt<span style="letter-spacing: -.1pt;">i</span>c<span style="letter-spacing: -.05pt;">c</span>r<span style="letter-spacing: -.2pt;">o</span>sscla<span style="letter-spacing: -.1pt;">m</span>pti<span style="letter-spacing: -.15pt;">m</span>ew<span style="letter-spacing: -.15pt;">a</span>s4<span style="letter-spacing: -.1pt;">0</span>-<span style="letter-spacing: -.05pt;">1</span><span style="letter-spacing: -.2pt;">2</span>5<span style="letter-spacing: -.05pt;">minut</span><span style="letter-spacing: -.1pt;">e</span>s.<span style="letter-spacing: -.15pt;">T</span>he <span style="letter-spacing: -.1pt;">patient</span>s<span style="letter-spacing: -.1pt;">h</span><span style="letter-spacing: -.15pt;">a</span>d<span style="letter-spacing: -.1pt;">(inc</span><span style="letter-spacing: -.15pt;">l</span><span style="letter-spacing: -.1pt;">udi</span><span style="letter-spacing: -.15pt;">n</span>g<span style="letter-spacing: -.1pt;">L</span><span style="letter-spacing: -.15pt;">A</span><span style="letter-spacing: -.05pt;">D</span>)<span style="letter-spacing: -.1pt;">2-</span>4<span style="letter-spacing: -.1pt;">v</span><span style="letter-spacing: -.15pt;">e</span><span style="letter-spacing: -.1pt;">sse</span>l<span style="letter-spacing: -.1pt;">dise</span><span style="letter-spacing: -.15pt;">a</span><span style="letter-spacing: .15pt;">s</span><span style="letter-spacing: -.2pt;">e</span>s.<span style="letter-spacing: -.1pt;">T</span><span style="letter-spacing: -.15pt;">h</span>e<span style="letter-spacing: -.1pt;">averag</span>e<span style="letter-spacing: -.05pt;">I</span><span style="letter-spacing: -.1pt;">C</span>U<span style="letter-spacing: -.05pt;">s</span><span style="letter-spacing: -.1pt;">ta</span>y<span style="letter-spacing: -.1pt;">wa</span>s<span style="letter-spacing: -.2pt;">2</span>9<span style="letter-spacing: -.1pt;">±1</span>4<span style="letter-spacing: -.1pt;">h</span><span style="letter-spacing: -.15pt;">o</span><span style="letter-spacing: -.1pt;">ur</span>s<span style="letter-spacing: -.2pt;">a</span>nd meanh<span style="letter-spacing: -.2pt;">o</span>spit<span style="letter-spacing: -.2pt;">a</span>lstayw<span style="letter-spacing: -.15pt;">a</span>s5dayswithnocompl<span style="letter-spacing: -.2pt;">i</span>cati<span style="letter-spacing: -.15pt;">on</span>s<span style="letter-spacing: -.1pt;">ap</span><span style="letter-spacing: -.15pt;">a</span>rt<span style="letter-spacing: -.1pt;">f</span>r<span style="letter-spacing: -.15pt;">o</span>m<span style="letter-spacing: -.1pt;">atria</span>l<span style="letter-spacing: -.1pt;">fibril</span><span style="letter-spacing: -.15pt;">l</span>a<span style="letter-spacing: -.1pt;">tio</span>n<span style="letter-spacing: -.1pt;">(n=4</span>,<span style="letter-spacing: -.1pt;">18.2%). </span>Thefoll<span style="letter-spacing: -.2pt;">o</span>w-<span style="letter-spacing: -.15pt;">u</span>pperi<span style="letter-spacing: -.15pt;">o</span>dra<span style="letter-spacing: -.15pt;">n</span>g<span style="letter-spacing: -.2pt;">e</span>d<span style="letter-spacing: -.05pt;">f</span>rom4to<span style="letter-spacing: -.2pt;">1</span>4mont<span style="letter-spacing: -.2pt;">h</span>s.On<span style="letter-spacing: -.05pt;">t</span>he40thp<span style="letter-spacing: -.1pt;">o</span><span style="letter-spacing: -.05pt;">stoperativ</span>e<span style="letter-spacing: -.15pt;">d</span><span style="letter-spacing: -.2pt;">a</span><span style="letter-spacing: -.1pt;">y</span>,c<span style="letter-spacing: -.05pt;">oro</span><span style="letter-spacing: -.2pt;">n</span><span style="letter-spacing: -.05pt;">ar</span>y<span style="letter-spacing: -.05pt;">CT </span><span style="letter-spacing: -.1pt;">angi</span><span style="letter-spacing: -.15pt;">o</span>g<span style="letter-spacing: -.1pt;">r</span><span style="letter-spacing: -.15pt;">a</span><span style="letter-spacing: -.1pt;">ph</span>y<span style="letter-spacing: -.1pt;">reveale</span>d<span style="letter-spacing: -.15pt;">p</span>a<span style="letter-spacing: -.1pt;">t</span><span style="letter-spacing: -.15pt;">e</span><span style="letter-spacing: -.1pt;">n</span>t<span style="letter-spacing: -.1pt;">grafts</span>.<span style="letter-spacing: -.1pt;">N</span>o<span style="letter-spacing: -.1pt;">patien</span>t<span style="letter-spacing: -.1pt;">die</span>d<span style="letter-spacing: -.1pt;"> du</span>e<span style="letter-spacing: -.1pt;">t</span>o<span style="letter-spacing: -.1pt;">CAD.</span></span> <span style="font-size: 10.0pt; font-family: 'Arial','sans-serif'; letter-spacing: -.1pt;">I</span><span style="font-size: 10.0pt; font-family: 'Arial','sans-serif';">n<span style="letter-spacing: -.05pt;">c</span><span style="letter-spacing: -.1pt;">o</span><span style="letter-spacing: -.15pt;">n</span>c<span style="letter-spacing: -.1pt;">l</span><span style="letter-spacing: -.15pt;">u</span><span style="letter-spacing: -.05pt;">s</span><span style="letter-spacing: -.1pt;">i</span><span style="letter-spacing: -.2pt;">o</span>n,<span style="letter-spacing: -.05pt;">c</span><span style="letter-spacing: -.1pt;">oron</span><span style="letter-spacing: -.15pt;">a</span><span style="letter-spacing: -.1pt;">r</span>y<span style="letter-spacing: -.1pt;">end</span><span style="letter-spacing: -.15pt;">a</span><span style="letter-spacing: -.1pt;">rterect</span><span style="letter-spacing: -.2pt;">o</span><span style="letter-spacing: -.1pt;">m</span>y<span style="letter-spacing: -.1pt;">an</span>dan<span style="letter-spacing: -.2pt;">g</span><span style="letter-spacing: -.1pt;">i</span>op<span style="letter-spacing: -.05pt;">l</span><span style="letter-spacing: -.15pt;">a</span>s<span style="letter-spacing: -.1pt;">t</span>y<span style="letter-spacing: -.05pt;">i</span>sasa<span style="letter-spacing: .05pt;">f</span>ea<span style="letter-spacing: -.2pt;">n</span>d<span style="letter-spacing: -.2pt;">h</span><span style="letter-spacing: -.1pt;">i</span>ghlyr<span style="letter-spacing: -.15pt;">e</span>w<span style="letter-spacing: -.1pt;">a</span>rd<span style="letter-spacing: -.2pt;">i</span>ng <span style="letter-spacing: -.1pt;">pr</span><span style="letter-spacing: -.15pt;">o</span>c<span style="letter-spacing: -.1pt;">e</span><span style="letter-spacing: -.15pt;">du</span><span style="letter-spacing: -.05pt;">r</span>e<span style="letter-spacing: -.1pt;"> i</span>n<span style="letter-spacing: -.1pt;"> potentiall</span>y<span style="letter-spacing: -.1pt;">inoper</span><span style="letter-spacing: -.15pt;">a</span>b<span style="letter-spacing: -.1pt;">l</span>e<span style="letter-spacing: -.1pt;"> pati</span><span style="letter-spacing: -.15pt;">e</span><span style="letter-spacing: -.1pt;">nt</span>s <span style="letter-spacing: -.1pt;">wit</span>h<span style="letter-spacing: -.1pt;"> diffu</span>seco<span style="letter-spacing: -.05pt;">r</span><span style="letter-spacing: -.1pt;">o</span><span style="letter-spacing: -.05pt;">n</span><span style="letter-spacing: -.1pt;">ar</span>y<span style="letter-spacing: -.1pt;">arter</span>y<span style="letter-spacing: -.1pt;"> di</span>se<span style="letter-spacing: -.1pt;">a</span><span style="letter-spacing: -.05pt;">s</span><span style="letter-spacing: -.1pt;">e</span>.</span>   <span style="mso-ignore: vglayout; position: absolute; z-index: 251661310; left: 0px; margin-left: 113px; margin-top: 35px; width: 182px; height: 4px;"></span><em><span style="font-size: 10.0pt; letter-spacing: -.1pt;">K</span></em><em><span style="font-size: 10.0pt;">ey<span style="letter-spacing: -.1pt;">w</span>o<span style="letter-spacing: -.15pt;">r</span>d<span style="letter-spacing: -.15pt;">s</span>:<span style="letter-spacing: -.15pt;">C</span>or<span style="letter-spacing: -.1pt;">o</span><span style="letter-spacing: -.05pt;">na</span>ryar<span style="letter-spacing: -.15pt;">t</span><span style="letter-spacing: -.1pt;">e</span>ryd<span style="letter-spacing: -.1pt;">i</span>s<span style="letter-spacing: -.15pt;">e</span>ase,<span style="letter-spacing: -.1pt;">e</span><span style="letter-spacing: -.05pt;">nd</span>ar<span style="letter-spacing: -.1pt;">t</span>erec<span style="letter-spacing: -.1pt;">to</span><span style="letter-spacing: -.05pt;">m</span>y,a<span style="letter-spacing: -.1pt;">n</span>g<span style="letter-spacing: -.1pt;">io</span>p<span style="letter-spacing: -.1pt;">l</span>as<span style="letter-spacing: -.1pt;">t</span><span style="letter-spacing: -.15pt;">y</span>,v<span style="letter-spacing: -.15pt;">e</span>n<span style="letter-spacing: -.1pt;">o</span>us,<span style="letter-spacing: -.05pt;">p</span>a<span style="letter-spacing: -.15pt;">t</span><span style="letter-spacing: -.05pt;">ch</span>,<span style="letter-spacing: -.1pt;">lef</span>tan<span style="letter-spacing: -.1pt;">t</span>e<span style="letter-spacing: -.15pt;">r</span><span style="letter-spacing: -.1pt;">i</span><span style="letter-spacing: -.05pt;">o</span>r desc<span style="letter-spacing: -.15pt;">e</span><span style="letter-spacing: -.05pt;">n</span>d<span style="letter-spacing: -.15pt;">i</span>n<span style="letter-spacing: -.1pt;">g</span>, <span style="letter-spacing: -.1pt;">lef</span>t<span style="letter-spacing: -.1pt;"> i</span>n<span style="letter-spacing: -.1pt;">te</span>r<span style="letter-spacing: -.05pt;">n</span>al<span style="letter-spacing: -.1pt;"> m</span><span style="letter-spacing: -.05pt;">a</span><span style="letter-spacing: -.1pt;">m</span>mary<span style="letter-spacing: -.05pt;">a</span>r<span style="letter-spacing: -.1pt;">te</span>ry.</span></em>