3D Rotational Angiography Research Articles

Atrial fibrillation recurrence rates in patients with transthyretin cardiac amyloidosis undergoing pulmonary vein isolation: a comparative retrospective study with propensity score matching

Abstract Background Atrial fibrillation (AF) affects up to 70% of individuals diagnosed with transthyretin cardiac amyloidosis (ATTR CA) [1]. AF ablation is frequently considered in the management of these patients, but there is a lack of data about outcomes of the procedure in this population. Purpose This study aims to evaluate AF recurrence rates and long-term AF recurrence-free survival in patients with ATTR CA undergoing pulmonary vein isolation (PVI). Methods A single-center retrospective study was conducted, including all patients diagnosed with ATTR CA who underwent PVI from 2016 to 2023. We compared patients with amyloidosis (cases) to those without (controls), employing propensity score matching for age, gender, AF type (paroxysmal vs. persistent), BMI, diabetes, arterial hypertension diagnosis, antiarrhythmic drug therapy post-index ablation, and left atrium (LA) volume assessed by 3D rotational angiography (3DRA). Results 16 patients with CA were matched to 16 patients without (32 patients in total). After matching, the populations demonstrated comparable baseline characteristics (figure 1). The study consistently revealed a higher AF recurrence rate, after PVI, in the CA group (81.3%) compared to the control group (37.5%) at the last follow-up (p-value 0.01) (median follow-up 1255 ± 1055 days in CA and 1491 ± 464 days in control group), as well as a significantly lower long-term AF-recurrence free survival (log-rank p = 0.01 – figure 2). Additionally, the recurrence rate at 1-year post-procedure was 56.25% in the CA group and 18.75% in the control group (p-value 0.03). Conclusions Pulmonary vein isolation remains a viable treatment option for individuals with ATTR CA. However, it proved less effective (or less durable) than in the general population without the disease, both at 1-year follow-up and for longer periods, as shown also with recurrence-free survival rate. Further studies are warranted to determine the optimal treatment strategy for this specific population.Baseline Characteristics fig. 1Kaplan Meyer fig. 2

Intraoperative contrast-enhanced cone beam CT allows visualization of the ‘dark side’ of the clot and improves mechanical thrombectomy performance

BackgroundVisualization of the clot is key to the endovascular treatment of ischemic stroke, but identification of the distal part of the clot and distal arteries during mechanical thrombectomy (MT) remains...

Evaluation of micro-remnant niduses of arteriovenous malformations post-gamma knife radiosurgery by 3D-rotational angiography.

Recent innovations in radiological imaging have enabled the detection of micro-remnant niduses of arteriovenous malformations (AVMs) after gamma knife radiosurgery (GKS), which have not been previously perceptible. Herein, we focus on the difficulty of evaluating micro-remnant AVMs after GKS that are hardly perceptible on conventional examinations and propose integrating follow-up three-dimensional rotational angiography (3D-RA) in the previous gamma plan as a solution. We retrospectively searched NTT Medical Center Tokyo hospital database for patients with AVMs who underwent both two-dimensional digital subtraction angiography (2D-DSA) and 3D-RA as follow-up for GKS from February 2021 to January 2024. Patients with suspected nidus occlusion on the latest non-contrast-enhanced magnetic resonance angiography (NC-MRA) were included, and contrast-enhanced magnetic resonance angiography (CE-MRA), 2D-DSA, and 3D-RA were evaluated. Twelve patients with 13 AVM sites were defined as having complete nidus occlusion on upfront NC-MRA. On 2D-DSA, seven AVM sites showed the presence of slight remaining AVMs based on the detection of remnant drainage veins, however the nidus was not detected in three cases. Nevertheless, 3D-RA detected micro-remnant niduses in all seven AVM sites, and four patients underwent re-GKS. Nine patients with ten AVM sites also underwent CE-MRA, and six AVM sites were diagnosed with radiation-induced parenchymal injury. Importing the 3D-RA image into the treatment planning has the potential to be more helpful than NC-MRA or CE-MRA to detect micro-remnant AVMs and evaluate the true remnant volume, and may contribute to a more detailed treatment planning, thereby improving the results of GKS retreatment.

High variability in physician estimations of flow-diverting stent deployment versus PreSize Neurovascular software simulation: a comparison study

BackgroundPhysician variablity in preoperative planning of endovascular implant deployment and associated inaccuracies have not been documented. This study aimed to quantify the variability in accuracy of physician flow diverter (FD)...

Three-dimensional Images Fusion Method Useful for Preoperative Simulation of Clipping Surgery for Cerebral Aneurysms.

This study aimed to introduce a three-dimensional (3D) images fusion method for preoperative simulation of aneurysm clipping. Consecutive unruptured aneurysm cases treated with surgical clipping from March 2021 to October 2023 were included. In all cases, preoperative images of plain computed tomography (CT), CT angiography, magnetic resonance imaging (MRI) 3D fluid-attenuated inversion recovery, 3D heavily T2-weighted images, and 3D rotational angiography were acquired and transported into a commercial software (Ziostation2 Plus, Ziosoft, Inc. Tokyo, Japan). The software provided 3D images of skull, arteries including aneurysms, veins, and brain tissue that were freely rotated, magnified, trimmed, and superimposed. Using the 3D images fusion method, two operators predicted clips to be used in the following surgery. The predicted clips and actually used ones were compared to give agreement scores for the following factors: (1) type of clips (simple or fenestrated), (2) shape of clips (straight, curved, angled, or bayonet), and (3) clipping strategy (single or multiple). The agreement score ranged from 0 to 3 because a score of 1 or 0 was given for agreement or disagreement on each factor. Interoperator reproducibility was also evaluated. During the study period, 44 aneurysms from 37 patients were clipped. All procedures were successfully completed, thanks to the precisely reproduced surgical corridors with the 3D images fusion method. Agreement in clip prediction was good with mean agreement score of 2.4. Interobserver reproducibility was also high with the kappa value of 0.79. The 3D images fusion method was useful for preoperative simulation of aneurysm clipping.

Anterior Choroidal Artery Aneurysm Clipping: Angiographic Diagnostics and Surgical Tactics Focused on Visualizing the Anterior Choroidal Artery Behind the Aneurysm

This study describes our experiences with AChA aneurysm clipping with a focus on visualizing the anterior choroidal artery (AChA) just behind the aneurysm to identify the risk factors for adhesion of the AChA or its branches to the posterior wall of the AChA aneurysm. The initial segment of the AChA just behind the aneurysm was evaluated preoperatively using 3D rotational angiography and its course was designated as posteromedial, posterior, or posterolateral. The posterior aspect of the AChA aneurysm was inspected intraoperatively using an endoscope or micromirror. Based on 3D rotational angiography, the main trunk of the AChA showed a posteromedial (n = 47, 57.3%), posterior (n = 18, 22.0%), or posterolateral (n = 17, 20.7%) course just behind the aneurysm. Intraoperatively, 14.6% (12 of 82) of the clipped AChA aneurysms revealed an AChA branch adhered to the posterior wall of the aneurysm. A multivariate analysis revealed that the posterior or posterolateral course of the initial segment of the AChA was a statistically significant risk factor for adhesion of an AChA branch to the posterior wall of the aneurysm (OR 21.083, 95% CI 2.567-173.166, p = 0.005). The initial course of the AChA just behind an AChA aneurysm can be evaluated using 3D rotational angiography. In contrast to a posteromedial course, a posterior or posterolateral course of the AChA just behind an AChA aneurysm can be a significant risk factor for adhesion of an AChA branch to the posterior wall of an AChA aneurysm.

Preoperative Angiographic Protocol for the Surgical Management of Spinal Dural Arteriovenous Fistulas: A Technical Nuance for Safe Minimally Invasive Surgery

BackgroundInterruption of the fistoulus point is the goal of the treatment of spinal dural arteriovenous fistula (dAVFs). Microsurgery still represents a highly efficient treatment in terms of complete occlusion with the lowest risk of recurrence rate. It is reported that the hardest step consists in finding the fistulous site itself, potentially extending surgical access and time, and increasing potential post-operative surgical-related complications. The accurate preoperative detection of the shunt and spinal level together is crucial for guiding optimal, fast and safe microsurgical treatment. MethodsIn the present paper, the authors describe a preoperative angiographic protocol for achieving a safe and simple resection of spinal dAVFs based on a six-year Institutional experience of forty-two patients who underwent minimally invasive. Two illustrative cases are also included in order to support the technical descriptions. ResultsThe suspected artery associated to the vascular malformation of interest is studied in our angiographic protocol through non-subtracted selective acquisitions in the lateral projection. The resulting frames are reconstructed with 3D Rotational Angiography. The implementation of the preoperative angiographic protocol allowed 100% of intraoperative identification of the fistoulus point in all cases with the use of minimally invasive approach. ConclusionsNowadays, neurosurgeons advocate for minimally invasive procedures and low morbidity risk procedures for the treatment of spinal dAVFs.Our preoperative approach for accurate angigoraphic localization of the fistoulus point through non-subtracted and 3D reconstructed angiography allowed to achieve safe and definitive occlusion of the shunt.

Weighted CTDI Equation for 3D Rotational Angiography: A Monte Carlo Study

This study aims to verify the weighted Computed Tomography Dose Index (CTDIw) coefficients of 3D rotational angiography (3DRA) procedure using Monte Carlo simulation. The Monte Carlo simulation EGSnrc usercode was employed for 3D dose simulations of the rotational angiography procedure. A virtual phantom resembles the head CTDI phantom was constructed, with a diameter of 16 cm and a density resembling polymethyl methacrylate (1.13 g/cm3). A series of virtual phantoms consisting of 5 images with ionization chamber detectors at the center position, 12 o'clock, 9 o'clock, 6 o'clock, and 3 o'clock were acquired. Simulations were performed with photon sources of 70 and 109 kVp for 200-degree x-ray tube rotation. The field of view was divided into narrow, wide, and full beam with diameters of 1.7 cm; 4.9 cm; and 8.6 cm, respectively. The simulated doses at the ionization chamber were processed into weighting factor for weighted CTDI and compared with direct measurements. The dose ratio between peripheral and center positions for 360° CBCT and 200° 3DRA was 1:1 and 1:3 in this study. The weighting factors for 3DRA were determined as CTDIcenter = ¼ and CTDIperiphery = ¾. The measured average percentage difference of CTDIw between our weighted factor and conventional CTDIw was 1.75 % (-3.99 % to 6.08 %). The x-ray tube position of 3DRA impacted the accuracy of weighting factor of CTDIw, with implications for the proposed weighting factor (Wcenter = ¼ and Wperiphery = ¾) when using a 3DRA machine.

Computational Fluid Dynamic Assessment of Patients with Congenital Heart Disease from 3D Rotational Angiography.

For congenital heart disease patients, multiple imaging modalities are needed to discern anatomy and functional information such as differential blood flow. During cardiac catheterization, 3D rotational angiography (3DRA) can provide CTA-like images, enabling anatomical information and intraprocedural guidance. We seek to establish whether unique aspects of this technique can also generate quantitative functional blood flow information. We propose that systematic integration of 3DRA imaging, catheter hemodynamic information, and computational fluid dynamics (CFD), can provide quantitative information regarding blood flow dynamics and energetics, without additional imaging or procedures. We report a single center retrospective feasibility study comprising four patients with 3DRA imaging and a complete set of hemodynamic data. 3DRA was processed and segmented to reconstruct vascular regions of interest (ROI), and a computational grid for CFD modeling of blood flow through the ROI was generated. Blood flow was simulated by integrating catheter hemodynamic data to devise boundary conditions at vascular ROI inlets and outlets. The 3DRA-based workflow successfully generated key computational outputs commonly used for cardiovascular applications, including flow patterns, distribution fractions, wall shear stress. Computational outputs obtained were as detailed and resolved as those obtained from more commonly used CT or MR angiography. Accuracy was confirmed by comparing computed flow distributions with measurements for 2 cases, showing less than 2.0% error from the measured data. Systematic integration of catheter hemodynamic information, 3DRA imaging, and CFD modeling, provides an effective and feasible alternative to obtain important quantitative blood flow information and visualization, without additional imaging.

Combining Machine-Measured Morphometric, Geometric, and Hemodynamic Factors to Predict the Risk of Aneurysm Rupture at the Middle Cerebral Artery Bifurcation

Middle Cerebral Artery Bifurcation Aneurysm (MbifA) is associated with a high risk of rupture and poor overall prognosis in patients once it ruptures. Morphological, geometric, and hemodynamic parameters have been identified as factors contributing to the rupture of intracranial aneurysms. However, there are no studies that combine these 3 types of parameters to specifically target MbifA rupture. This study enrolled all patients with MbifAs diagnosed at our treatment center from 1 April 2021 to 31 July 2023 who met the study criteria. All patients underwent digital subtraction angiography examination to obtain 3D rotational angiography data. We imported the complete image data into the Aneurysm/Artery Reconstruction and Analysis machine to obtain 13 morphological parameters (Dneck, Ddome, Height, Dmax, Dartery, aspect ratio [AR], size ratio, dome-neck-ratio [DNR], height-artery-ratio, bottleneck factor, Inflow Angle, Incline Angle, Arterial Angle), 5 geometric parameters (V,S,undulation index [UI], ellipticity index [EI],nonsphericity index [NSI]), and 5 hemodynamic parameters (wall shear stress [WSS], the maximum WSS, the parent artery WSS, the normalized WSS [NWSS], oscillatory shear index [OSI]). All the above significant parameters were tested by univariate and multivariate analyses to find out the independent discriminatory factors. A total of 49 MbifAs (16 ruptured and 33 unruptured) from 44 patients were included in the study. Height (P= 0.033), AR (P= 0.007), DNR (P= 0.011), EI (P= 0.042), NSI(P= 0.030), UI(P= 0.027), WSS(P= 0.033), and NWSS(P= 0.002) were all associated with MbifA rupture in univariate analyses, but only NWSS was an independent risk factor (P= 0.036, OR=0.046, 95% CI: 0.003-0.815) in multivariate logistic regression analysis. Height, AR, DNR, EI, UI, NSI, WSS, and NWSS may be correlated with MbifA rupture, but only NWSS was an independent risk factor. A lower NWSS was associated with a higher risk of MbifA rupture. No significant differences were observed in the angle parameters, including the Inflow Angle, between ruptured and unruptured MbifAs. OSI was significantly increased at the dome of the aneurysm but the mean OSI was not found to be associated with MbifA rupture.

Radiological evaluation of middle meningeal artery by 3D rotational angiography.

This study aimed to evaluate the topographic features and branches of the middle meningeal artery (MMA) by three-dimensional rotational angiography (3DRA) and describe its variations' radiological classification based on previous clinical examples of cadaver studies and literature. We consecutively evaluated 87 cerebral hemispheres, including 32 females and 49 right sides between May 2020 and December 2021 who had undergone unilateral or bilateral cerebral and carotid artery 3D rotational angiography imaging by CCA injection and between 18 and 76-years-old. Maximum intensity projection images with 10-30 mm slice thickness were used for the morphological evaluations and measurements of MMA and its foramen, canal, and branches. The diameters of the common carotid artery, internal carotid artery, and external carotid artery were significantly smaller in females than in men (p = 0.021, 0.021, and <0.001, respectively). According to the branching pattern, the most common pattern of the MMA was Type Ia (49.4%). The ophthalmic artery completely originated from MMA in the 1 (1.1%) cerebral hemisphere. The MMA arises from the ophthalmic artery in 2 cerebral hemispheres (2.3%), and the ophthalmic artery and maxillary artery in 2 cerebral hemispheres (2.3%). It was observed that the branching pattern may show differences when compared to the cadaver studies with a radiologic evaluation with 3D-RA.

Three-Dimensional (3D) Microcatheter Shaping Using Touch Screen Devices for Cerebral Aneurysm Coil Embolization

In cerebral aneurysm coil embolization, proper microcatheter shaping is crucial to reduce complications and achieve sufficient embolization. Shaping a microcatheter in 3 dimensions (3D) is often required but can be challenging. We assessed the usefulness of a novel shaping on screen (SOS) method that displays real-size 3D rotational angiography (RA) images on a touch screen device during cerebral aneurysm embolization to facilitate 3D microcatheter shaping. In this study, 18 patients with cerebral aneurysm treated with this technique were included. Real-size 3D-RA images obtained during the embolization procedure were displayed on the touch screen device, which allowed for real-time manipulation. The shape of the microcatheter was adjusted to conform to the curvature of the vessel by swiping the touch screen device and bending the mandrel accordingly. We assessed the clinical and angiographic results, along with the accuracy and stability of the microcatheter. No procedure-related complications were observed. The mean packing density was 41%±12%. In all but 1 case, microcatheters were inserted into the aneurysms without guidewire assistance. After coiling, all microcatheter forms were stable. Three-dimensional (3D) microcatheter shaping using touch screen devices during cerebral aneurysm coil embolization may be simple and safe and can achieve high packing density of aneurysms.

Modern tools in congenital heart disease imaging and procedure planning: a European survey.

Congenital heart diseases (CHDs) often show a complex 3D anatomy that must be well understood to assess the pathophysiological consequences and to guide therapy. Three-dimensional imaging technologies have the potential to enhance the physician's comprehension of such spatially complex anatomies. Unfortunately, due to the new introduction in clinical practice, there is no evidence on the current applications. We conducted a survey to examine how 3D technologies are currently used among CHD European centres. Data were collected using an online self-administered survey via SurveyMonkey. The questionnaire was sent via e-mail and the responses were collected between January and June 2022. Ninety-eight centres correctly completed the survey. Of these, 22 regularly perform 3D rotational angiography, 43 have the availability to print in-silico models, and 22 have the possibility to visualize holographic imaging/virtual reality. The costs were mostly covered by the hospital or the department of financial resources. From our survey, it emerges that these technologies are quite spread across Europe, despite not being part of a routine practice. In addition, there are still not enough data supporting the improvement of clinical management for CHD patients. For this reason, further studies are needed to develop clinical recommendations for the use of 3D imaging technologies in medical practice.

Abstract 15800: Evaluating the Correlation Between Right Ventricular Outflow Tract Dimensions and Arrhythmia Risk Following Self-Expanding Transcatheter Pulmonary Valve Replacement

Introduction: The introduction of self-expanding valves has allowed for an expanded range of patients who can be treated with transcutaneous pulmonary valve replacement (TPVR). Though major complications are rare, ventricular tachycardia has been reported following self-expanding valve placement prompting investigation of potential risk factors. Hypothesis: Significant variation in valve dimensions within the right ventricular outflow tract (RVOT) throughout the cardiac cycle is postulated as a cause for increased arrhythmia risk. We hypothesized that greater dynamic variation of the valve in the RVOT correlates to higher ventricular arrythmia risk. Methods: A single center review was performed of patients who underwent TPVR with either Harmony TPV or Alterra Pre-stent with subsequent placement of 29mm Sapien valve between 2019 and 2023. Using post-procedural 3D rotational angiography, minimum (systole) and maximum (diastole) diameters (mm), perimeter (mm) and cross-sectional area (mm 2 ) of the valve frame were measured in two locations: closest to the branch pulmonary artery bifurcation and the RV cavity. Results: Twenty-eight patients were included (14 Harmony TPV, 14 Alterra). Higher frequency of ventricular arrythmia was seen in patients with congenital pulmonary stenosis ( p =0.004). Higher ventricular arrythmia rate was associated with larger diastolic diameter (34.1 vs 33.2mm, p =0.04), mean perimeter (118.3 vs 108.6mm, p =0.03) and area (1124.5 vs 926.2mm 2 , p =0.03) of the valve frame closest to the RV cavity. Conclusions: Increased movement of the valve frame close to the RV cavity may correlate with a higher ventricular arrythmia risk due to increased contact with the native RVOT throughout the cardiac cycle. Future studies should focus on more accurate, mathematical methodology to better understand whether the complex interaction between self-expanding valves and the native RVOT is a determinant for post-procedural ventricular arrythmia.

Navigating complexity: a comprehensive review of microcatheter shaping techniques in endovascular aneurysm embolization

The endovascular intervention technique has gained prominence in the treatment of intracranial aneurysms due to its minimal invasiveness and shorter recovery time. A critical step of the intervention is the shaping of the microcatheter, which ensures its accurate placement and stability within the aneurysm sac. This is vital for enhancing coil placement and minimizing the risk of catheter kickback during the coiling process. Currently, microcatheter shaping is primarily reliant on the operator's experience, who shapes them based on the curvature of the target vessel and aneurysm location, utilizing 3D rotational angiography or CT angiography. Some researchers have documented their experiences with conventional shaping methods. Additionally, some scholars have explored auxiliary techniques such as 3D printing and computer simulations to facilitate microcatheter shaping. However, the shaping of microcatheters can still pose challenges, especially in cases with complex anatomical structures or very small aneurysms, and even experienced operators may encounter difficulties, and there has been a lack of a holistic summary of microcatheter shaping techniques in the literature. In this article, we present a review of the literature from 1994 to 2023 on microcatheter shaping techniques in endovascular aneurysm embolization. Our review aims to present a thorough overview of the various experiences and techniques shared by researchers over the last 3 decades, provides an analysis of shaping methods, and serves as an invaluable resource for both novice and experienced practitioners, highlighting the significance of understanding and mastering this technique for successful endovascular intervention in intracranial aneurysms.

Intraoperative angiography in neurosurgery: temporal trend, access site, and operative indication considerations from a 6-year institutional experience.

Historically, the transfemoral approach (TFA) has been the most common access site for cerebral intraoperative angiography (IOA). However, in line with trends in cardiac interventional vascular access preferences, the transradial approach (TRA) and transulnar approach (TUA) have been gaining popularity owing to favorable safety and patient satisfaction outcomes. To compare the efficacy and safety of TRA/TUA and TFA for cerebral and spinal IOA at an institutional level over a 6-year period. Between July 2016 and December 2022, 317 angiograms were included in our analysis, comprising 60 TRA, 10 TUA, 243 TFA, and 4 transpopliteal approach cases. Fluoroscopy time, contrast dose, reference air kerma, and dose-area products per target vessel catheterized were primary endpoints. Multivariate regression analyses were conducted to evaluate predictors of elevated contrast dose and radiation exposure and to assess time trends in access site selection. Contrast dose and radiation exposure metrics per vessel catheterized were not significantly different between access site groups when controlling for patient position, operative region, 3D rotational angiography use, and different operators. Access site was not a significant independent predictor of elevated radiation exposure or contrast dose. There was a significant relationship between case number and operative indication over the study period (P<0.001), with a decrease in the proportion of cases for aneurysm treatment offset by increases in total cases for the management of arteriovenous malformation, AVF, and moyamoya disease. TRA and TUA are safe and effective access site options for neurointerventional procedures that are increasingly used for IOA.

4D-DSA for Assessment of the Angioarchitecture and Grading of Cranial Dural AVF.

Time-resolved 3D rotational angiography (4D-DSA) has been used to demonstrate details of the angioarchitecture of AVM, whereas it has rarely been used to describe features of dural AVF. In this exploratory study, we analyzed dural AVFs with a novel 4D software prototype, developed and provided by Siemens, to determine whether identification of the location of the fistulous point, grading, and treatment planning were feasible. 4D-DSA volumes were calculated from existing 3D rotational angiography data sets of patients with dural AVFs. The 4D-DSA volumes were displayed in a virtual DSA mode and MPR or MIP in 3 orthogonal planes and compared with 2D-DSA by 2 experienced neuroradiologists. Fusions with unenhanced CT or MR images were used to improve visualization of adjacent anatomic structures. Comparison with 2D-DSA showed that evaluation of the fistulous point and grading according to the classification of Borden, Cognard, or Barrow was feasible in 26 of 27 cases. In 8 of 27 cases, 4D-DSA was considered advantageous for determining the fistulous point and the course of the draining vein in the dural AVF with cortical venous drainage, especially in the frontoethmoidal and frontoparietal regions. In 6 cases, the display of angioarchitecture was considered inferior to that of 2D-DSA due to motion artifacts, suboptimal selection of the injected vessel, and lack of temporal resolution. Detailed analysis of dural AVFs according to the standardized display of 4D-DSA volumes was feasible and helpful in understanding the angioarchitecture in selected cases. Further improvement and validation of the 4D software should solidify the complementary role of 4D-DSA to conventional 2D-DSA series.

Impact of a selective lens dose reduction protocol in 3D rotational angiography on radiation exposure to the eye lens during cerebral angiography: a randomized controlled trial

BackgroundWe aimed to investigate the radiation dose to the eye lens (lens dose) during cerebral angiography and to evaluate the effectiveness of the lens dose reduction protocol for 3-dimensional rotational...

Augmented Reality Visualization of 3D Rotational Angiography in Congenital Heart Disease: A Comparative Study to Standard Computer Visualization.

Augmented reality (AR) visualization of 3D rotational angiography (3DRA) provides 3D representations of cardiac structures with full visualization of the procedural environment. The purpose of this study was to evaluate the feasibility of converting 3DRAs of congenital heart disease patients to AR models, highlight the workflow for 3DRA optimization for AR visualization, and assess physicians' perceptions of their use. This single-center study prospectively evaluated 30 retrospectively-acquired 3DRAs that were converted to AR, compared to Computer Models (CM). Median patient age 6.5years (0.24-38.8) and weight 20.6kg (3.4-107.0). AR and CM quality were graded highly. RV pacing was associated with higher quality of both model types (p = 0.02). Visualization and identification of structures were graded as "very easy" in 81.1% (n = 73) and 67.8% (n = 61) of AR and CM, respectively. Fifty-nine (66%) grades 'Agreed' or 'Strongly Agreed' that AR models provided superior appreciation of 3D relationships; AR was found to be least beneficial in visualization of aortic arch obstruction. AR models were thought to be helpful in identifying pathology and assisting in interventional planning in 85 assessments (94.4%). There was significant potential seen in the opportunity for patient/family counseling and trainee/staff education with AR models. It is feasible to convert 3D models of 3DRAs into AR models, which are of similar image quality as compared to CM. AR models provided additional benefits to visualization of 3D relationships in most anatomies. Future directions include integration of interventional simulation, peri-procedural counseling of patients and families, and education of trainees and staff with AR models.

Safety Aspects and Procedural Characteristics of Ambulatory Diagnostic Cerebral Catheter Angiography.

Diagnostic cerebral catheter angiography is used to assess avariety of neurovascular pathologies especially in patients before and after endovascular neurointerventional treatment. In many centers diagnostic cerebral angiographies are performed with the patient staying for one night in the hospital because there are not yet sufficient data on the safety of ambulatory cerebral angiography. At the same time hospitals face agrowing demand to perform ambulatory medical procedures. A total of 426 ambulatory diagnostic cerebral angiographies were retrospectively analyzed. Technical details of the angiographies were analyzed to identify procedural risk factors. Out of 426 patients 14 (3.3%) had some form of complication, 3 developed minor transient neurological symptoms, 1 patient developed Quincke's edema probably as an adverse reaction to contrast agent, 1 patient had an asymptomatic carotid dissection and 1 had afall of unknown etiology. Of the 14complications 8 were puncture site complications with 1 re-bleeding, 1 dissection, and 6 minor complications, 421 punctures were femoral, 3 radial and 2 brachial. Out of 333 patients with magnetic resonance imaging (MRI) after angiography 21 showed focal diffusion-weighted imaging (DWI) lesions but none of these lesions were symptomatic. The rate of DWI lesions was significantly higher in selectively angiography territories than in other territories. The use of aSimmons 2catheter significantly increased the rate of DWI lesions (p = 0.047), whereas 3D rotational angiography did not (p = 0.55). The rate of DWI lesions per selectively accessed vessel was 4.6% with ahigher rate in the anterior than in the posterior circulation. Diagnostic cerebral catheter angiography can be safely performed in an ambulatory setting.