Intra-arterial haemodynamic changes during cerebral three-dimensional rotational angiography

Abstract

Three-dimensional rotational angiography (3DRA) is useful for detecting, classifying and planning treatment for intracranial aneurysms. Prolonged contrast material (CM) injection, required for 3DRA, might cause blood pressure changes in the selectively catheterized artery. The purpose of this study was to assess the extent and clinical relevance of haemodynamic changes in the selected artery during 3DRA. Twenty-five consecutive patients with intracranial aneurysms were prospectively examined with 3DRA (18 ml, 3 ml/s power injector) for planning treatment. Intra-arterial pressure was measured in the internal carotid or vertebral artery by using a pressure guidewire. Mean and systolic blood pressure acquired by the guidewire (Pd) and fractional flow reserve (FFR) were measured before, during and after CM injection. The extent of Pd and FFR changes was evaluated by Student's t-test and linear regression analysis and their clinical relevance with the limits-of-agreement analysis. Mean systolic Pd and FFR increased significantly (P<0.001) from 105.2+/-22 mmHg and 0.98+/-0.04, respectively, at the baseline to 118.1+/-23 mmHg and 1.09+/-0.12, respectively, during injection and decreased thereafter to baseline. The correlation between mean and systolic Pd during injection and at baseline was moderate (r(2)=0.47 and 0.63, respectively) but remained significant (P=0.001 and <0.001, respectively). Moderate bias and range of agreement were found for systolic Pd (12.8+/-29.2 mmHg) and FFR (0.1+/-0.24). Selective CM injection during 3DRA causes a temporary but clinically tolerable increase in blood pressure and pressure gradient.