Angiographic Procedures Research Articles

Coronary Microvascular Spasm: Clinical Presentation and Diagnosis.

Professor Maseri pioneered the research and treatment of coronary vasomotion abnormalities represented by coronary vasospasm and coronary microvascular dysfunction (CMD). These mechanisms can cause myocardial ischaemia even in the absence of obstructive coronary artery disease, and have been appreciated as an important aetiology and therapeutic target with major clinical implications in patients with ischaemia with non-obstructive coronary artery disease (INOCA). Coronary microvascular spasm is one of the key mechanisms responsible for myocardial ischaemia in patients with INOCA. Comprehensive assessment of coronary vasomotor reactivity by invasive functional coronary angiography or interventional diagnostic procedure is recommended to identify the underlying mechanisms of myocardial ischaemia and to tailor the best treatment and management based on the endotype of INOCA. This review highlights the pioneering works of Professor Maseri and contemporary research on coronary vasospasm and CMD with reference to endothelial dysfunction, Rho-kinase activation and inflammation.

Comparing the Efficacy and Success Rate of Radial Artery Approach under Ultrasound Guidance and Palpation Technique for Coronary Intervention at Central Chest Institute of Thailand

Background: Previous studies of ultrasound guidance for transradial artery access during coronary angiography or interventional procedures demonstrate improving success rate, number of attempts, and short-time access in radial artery cannulation. Objective: To compare the benefit of ultrasound guidance radial artery access during coronary angiography (CAG) or percutaneous coronary intervention (PCI) with palpation technique in experienced and inexperienced operators. Materials and Methods: A randomized prospective study was performed between October 2021 and April 2022. One hundred sixty-four patients were randomized into three groups. The first group, group I (55 cases), underwent radial artery puncture with ultrasound guidance by an experienced interventionist. The second group, group II (56 cases), underwent radial artery puncture using the palpation technique by another experienced interventionist. The third group, group III (53 cases), was also assigned to radial artery puncture with the palpation technique, however, performed by three interventional cardiology fellows. Results: The success rate of radial cannulation was 55 (100%) in group I, 52 (92.9%) in group II, and 48 (90.6%) in group III (p=0.060). Firstattempt success rates in the three groups were 83.6%, 75%, and 69.8%, respectively (p=0.233). The median number of attempts was not significantly different (p=0.208). Time to access the radial artery in group I was reduced significantly compared to the palpation technique in group II and group III (p<0.001). There were no significant differences in complications such as difficult access, access site crossover, radial spasm, and hematoma/ bleeding complication (p=0.135, 0.367, 0.132, and 0.700, respectively). Conclusion: In experienced operators, an ultrasound-guided technique has been shown to have beneficial advantages in reducing the time to access radial artery cannulation compared to experienced and inexperienced operators using the palpation technique. Keywords: Transradial catheterization; Ultrasound guide

Spectrum of Complications and Complication Rates After Diagnostic Catheter Angiography in Neuroradiology

PurposeTo retrospectively evaluate the total complication rates and type of complications after diagnostic cerebral and spinal catheter angiography.MethodsData from 2340 patients undergoing diagnostic angiography over a period of 10 years in a neuroradiologic center were retrospectively evaluated. Local, systemic, neurological, and technical complications were analyzed.ResultsA total of 75 clinically noted complications occurred. The risk for clinical complications was increased when the angiography was performed under emergency conditions (p = 0.009). The most common complication was groin hematoma (1.32%). Neurological complications occurred in 0.68% of patients, of which 0.13% were stroke with permanent disability. Technical complications without noticeable clinical symptoms of the patients occurred in 2.35% of the angiographic procedures. Deaths caused by angiography did not occur.ConclusionThere is a definite risk for complications after diagnostic angiography. Although a very broad spectrum of complications was considered, complications in the individual subgroups showed a low incidence.

Comparing Radiation Dose of Cerebral Angiography Using Conventional and High kV Techniques: A Retrospective Study on Intracranial Aneurysm Patients and a Phantom Study.

Evaluation of patient radiation dose after the implementation of a high kV technique during a cerebral angiographic procedure is an important issue. This study aimed to determine and compare the patient radiation dose of intracranial aneurysm patients undergoing cerebral angiography using the conventional and high kV techniques in a retrospective study and a phantom study. A total of 122 cases (61 cases with conventional technique and 61 cases with high kV technique) of intracranial aneurysm patients, who underwent cerebral angiographic procedure and met the inclusion criteria, were recruited. The radiation dose and the angiographic exposure parameters were reviewed retrospectively. The radiation dose in the phantom study was conducted using nanoDotTM optically stimulating luminescence (OSLD), which were placed on the scalp of the head phantom, the back of the neck, and the phantom skin at the position of the eyes. The standard cerebral angiographic procedure using the conventional and high kV techniques was performed following the standard protocol. The results showed that the high kV technique significantly reduced patient radiation dose and phantom skin dose. This study confirms that the implementation of a high kV technique in routine cerebral angiography for aneurysm diagnosis provides an effective reduction in radiation dose. Further investigation of radiation dose in other interventional neuroradiology procedures, particularly embolization procedure, should be performed.

A130 ENDOSCOPIC ULTRASOUND GUIDED THROMBIN INJECTION: A NOVEL TECHNIQUE IN THE MANAGEMENT OF RECURRENT UPPER GASTROINTESTINAL BLEEDING CAUSED BY GASTRODUODENAL ARTERY PSEUDOANEURYSMS

Abstract Background Gastroduodenal artery (GDA) aneurysm is a rare vascular condition that is potentially life-threatening. It is associated with significant morbidity and mortality and most often encountered in patients with chronic pancreatitis. Other etiologies including atherosclerosis, peptic ulcer disease, alcohol abuse, cholecystectomy and absence of celiac axis, have been reported. False and true GDA aneurysms account for about 1.5% of all visceral artery aneurysms however are associated with a risk of rupturing and hemorrhage up to 75%. Mainstay of GDA aneurysm management involves aneurysm repair with open surgery with vessel ligation or endovascular repair with coil embolization or stent placement, depending on the patient’s comorbidities and overall hemodynamic stability. The use of percutaneous thrombin injection via computed tomography (CT) and ultrasound has also been described in the literature and is being increasingly used to promote clot formation and pseudoaneurysm occlusion as a less invasive option. Purpose To present a case of endoscopic ultrasound guided thrombin injection as an effective and safe management strategy for GDA pseudoaneurysms. Method At this time, there are limited data in the literature on endoscopic ultrasound guided thrombin injection for pseudoaneurysms. To our knowledge, this is the first case report describing a patient with recurrent gastrointestinal bleeding from a duodenal ulcer, who had undergone multiple endoscopic and angiographic procedures, with subsequent development of a gastroduodenal pseudoaneurysm unrelated to pancreatitis which was successfully managed by occluding the pseudoaneurysm with thrombin injection under endoscopic ultrasound guidance. EUS guided thrombin injection is a viable alternative to traditional interventional radiology guided thrombin injection for management of pseudoaneurysms. Result(s) In clinic follow-up three weeks after thrombin injection, our patient continued to do clinically well, without abdominal pain or symptoms. Repeat CT angiogram demonstrated the GDA pseudoaneurysm had remained thrombosed, indicating successful endoscopic obliteration. He had no further signs of gastrointestinal bleeding. Conclusion(s) EUS guided thrombin injection is a novel approach that has been presented as an option in the management of bleeding gastroduodenal pseudoaneurysms, especially when radiology guided or surgical options are higher risk or have previously failed. The paucity of available data highlights the need for ongoing clinical studies comparing the different therapeutic strategies that can effectively and safely manage these rare but life-threatening vascular entities. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

Role of angiography procedure for assessment the type of patent ductus arteriosus in children under 18 years.

Objective: To determine the role of angiography for the assessment the type of patent ductus arteriosus in children under 18 years. Study Design: Observational Retrospective study. Setting: Children’s Hospital Lahore. Period: October 2021 to February 2022. Material & Methods: The sample size calculated was 245 but, at the end of the period of four months only 120 patients fulfilled the criteria and were included in this study convenient sampling technique was used to collect the data. Patients with patent ductus arteriosus were included in this study. Patients with other congenital heart diseases were excluded. Essential measurements included Types of Patent Ductus Arteriosus (PDA), (PDA) Size, Ampulla Size, Aortic and Pulmonary systolic and diastolic pressures. Results: In this study 120 patients with PDA were included. Out of 120, 38 (31.7%) patients were male and 82 (68.3%) patients were female. The age range of the patients was 8 months to 18 years (mean;5.44 ± 3.972 years). The weight range of the patients was 5.3 to 41 Kg (mean;16.05 ± 8.38Kg). The mean PDA size was 4.01 ± 1.80. The mean Ampulla size was 9.92 ± 3.13. The types of PDA detected by angiography were Type A 59(49%), Type B 15(12.5%), Type C 20(16.7%), Type D 20(16.7%), Type E 5(4%), Type F 1(0.8%). The mean Aortic systolic pressure was 105.5±18.99 and diastolic pressure was 57.2 ±14.4. The mean Pulmonary Artery systolic pressure was 47.4 ± 23.3 and diastolic pressure was 27.7 ±14.2. Conclusion: Angiography was found more accurate for the assessment of all the anatomical types of PDA especially TYPE B, C, D and F. More precise measurements of the ampulla and PDA sizes were obtained using angiography. We may conclude that Angiography is a much better and good modality than other modalities for the assessment of the types of PDA.

Abstract No. 525 Investigation of an Ex Vivo Perfusion Model for Teaching Angiographic Procedures to Novice Trainees

Abstract No. 525 Investigation of an Ex Vivo Perfusion Model for Teaching Angiographic Procedures to Novice Trainees

Myocardial perfusion SPECT in Germany from 2012 to 2021: insights into development and quality indicators

PurposeThis paper summarises the results of 4 national surveys on the numbers, utilisation and technique of myocardial perfusion SPECT (MPS) from 2012 to 2021.MethodsA one-page questionnaire for information on MPS in 2012, 2015, 2018 and 2021 was sent to German centres practising nuclear medicine. To check for representativeness, the numbers obtained were related to official annual data and furthermore to the numbers of invasive coronary angiography procedures (ICA).ResultsMPS examinations increased by > 40% from 2012 to 2021 and showed a centralisation with increasing MPS per centre. In 2020, a mild impact of the COVID-19 pandemic could be observed in the form of only a slight MPS increase, which was compensated in the following year. Outpatient care cardiologists represent the most important referrer (70%). Mostly, 2-day protocols were used. One-day protocols and stress-only protocols showed insignificant changes. The use of exercise stress decreased steadily. In 2021, exercise stress was replaced by pharmacological stress as the most frequent stress modality. Camera systems showed a shift to more SPECT-CT systems. The use of gated SPECT increased to almost 90%. Quantitative scoring showed an increasing acceptance. The ratio of invasive coronary angiographies (ICA) to MPS was between 3.9 and 4.5. A significant proportion of ICA in the context of CCS (chronic coronary syndrome) was performed without prior testing for ischaemia.ConclusionThe 2012 to 2021 MPS surveys reveal a continuously growing number of examinations with only a mild temporary effect of the COVID-19 pandemic and a centralisation with increasing numbers per centre. Performance and technical data reveal a high-grade adherence of MPS practice to the current ESC guideline. A large potential of non-invasive diagnostics remains for the future.

Effectiveness of Calcium Channel Blockers and Nitrates in Inhibition of Spasm of Radial Artery during Coronary Angiography

Background: The most common issue with transradial cardiac catheterization is radial artery vasospasm. The patient experiences pain and discomfort as a result, the procedure is prolonged, and the interventionist may even be unable to continue. Aim: The aim of the study is to determine the effectiveness of Verapamil, a calcium channel blocker and nitrate, when used together to prevent radial artery spasm during coronary angiographies. Methods: This case control study was held in the Cardiology department of Qazi Hussain Ahmed Medical Complex, Nowshera and Peoples University of Medical and Health Sciences for Women PUMHSW (SBA) Nawabshah for six-months duration from July 2021 to December 2021 including 120 cardiac patients undergoing coronary angiography. The patients were selected by non-probability sampling technique. Patients who were enrolled in the study provided written informed consent. Two groups of patients—control (60) and experimental—were formed (60). Heparin/nitrate was administered to one group and labelled as a control group, while heparin/nitrates/verapamil (a calcium channel blocker) was administered to the other group considered as an experimental group. During the angiography procedure, the radial spasm, discomfort, and catheter resistance were assessed in both groups. A predesigned questionnaire was used to collect all other demographic data and patient’s history. SPSS version 23.0 was used to collect and analyse the data. Results: It was found that 68.3% of cardiac patients were over 50 years old, 41.7% of patients were female, and 58.3% of patients were male. Verapamil, a calcium channel blocker, and nitrate did not significantly affect radial spasm, according to this study with a p value of 0.762. According to the study, there was no obvious difference noted in radial spasm, outcome, discomfort, catheter resistance, or procedure time when cases and controls were compared for various variables. However, the test group have a 100% success rate of the procedure compared to the control group's 95%. Conclusion: Verapamil, a calcium channel blocker when combined with nitrate did not significantly reduce radial spasm during coronary angiography. The theory that calcium channel blockers could prevent radial artery spasm during angiography was nullified. It is best to avoid the financial burden that comes with using calcium channel blockers and nitrate during coronary angiography. Combining nitrate and calcium channel blocker (Verapamil) has no additional advantages. Keywords: Angiography, catheterization, calcium channel blocker, radial spasm, nitrate, and verapamil are some of the related terms.

Iliac Endovascular Intervention Without Procedural Anticoagulation.

Adequate antithrombotic therapy is essential to prevent thrombus formation during percutaneous endovascular interventions (PVI). We hypothesize that interventions for non-complex lesions of iliac arteries do not need procedural anticoagulation if patients are under dual antiplatelet therapy (DAPT). Iliac PVIs performed without procedural anticoagulation were retrospectively screened between 2017 and 2021. Baseline characteristics of patients, in-hospital events and 30-day follow-ups were obtained from hospital records. Each PVI was reviewed for procedural details. Primary safety outcome was thromboembolic events during intervention. Secondary safety outcome was adverse vascular events at 30-day follow-up. Procedure times of iliac interventions were compared to peripheral angiography procedures of patients with similar demographic characteristics. We identified 108 iliac interventions without procedural anticoagulation, median age of 62 (interquartile range 56-68) years, 9 (8.3%) females. Median lesion length was 30 (19-50) mm. We observed a thrombotic finding in 4 (3.7%) procedures. Visible luminal thrombus was observed in 2 (1.9%) and introducer sheath thrombosis in 2 procedures (1.9%), all of which were in patients with in-stent lesions. No distal embolization was observed in final angiography of these procedures. At 30-day follow-up, acute limb ischemia was not observed and clinically driven target vessel revascularization was not required in any of the patients. Procedure time of iliac interventions was similar to that of lower extremity diagnostic procedures [18 (11-24) vs 18 (14-24) min, respectively, P = .364]. No major bleeding event was observed after iliac interventions. Non-complex lesions of iliac arteries can be managed within a time frame similar to that of lower extremity diagnostic procedures. These interventions can be performed safely without procedural anticoagulation, provided patient receives DAPT. Intervention of in-stent lesions should ideally be avoided without procedural anticoagulation.

Anatomical variations of the circle of Willis and cerebrovascular accidents in transitional Albania

Aim: The purpose of this study was twofold: i) in a case-control design, to determine the relationship between anatomical variations of the circle of Willis and cerebrovascular accidents; ii) to assess the association between anatomical variations of the circle of Willis and aneurisms among patients with subarachnoid hemorrhage. Methods: A case-control study was conducted in Albania in 2013-2014, including 100 patients with subarachnoid hemorrhage and 100 controls (individuals without cerebrovascular accidents). Patients with subarachnoid hemorrhage underwent a CT angiography procedure, whereas individuals in the control group underwent a magnetic resonance angiography procedure. Binary logistic regression was used to assess the association between cerebrovascular accidents and the anatomical variations of the circle of Willis. Conversely, Fisher’s exact test was used to compare the prevalence of aneurisms between subarachnoid hemorrhage patients with and without anatomical variations of the circle of Willis. Results: Among patients, there were 22 (22%) cases with anatomical variations of the circle of Willis compared with 10 (10%) individuals in the control group (P=0.033). There was no evidence of a statistically significant difference in the types of the anatomical variations of the circle of Willis between patients and controls (P=0.402). In age- and-sex adjusted logistic regression models, there was evidence of a significant positive association between cerebrovascular accidents and the anatomical variations of the circle of Willis (OR=1.87, 95%CI=1.03-4.68, P=0.048). Within the patients’ group, of the 52 cases with aneurisms, there were 22 (42.3%) individuals with anatomical variations of the circle of Willis compared with no individuals with anatomical variations among the 48 patients without aneurisms (P<0.001). Conclusion: This study provides useful evidence on the association between anatomical variations of the circle of Willis and cerebrovascular accidents in transitional Albania. Furthermore, findings from this study confirm the role of the anatomical variations of the circle of Willis in the occurrence of cerebral aneurisms.

Ultrasound-Based Three-Dimensional Microangiography for Repeated Noninvasive Imaging of Neovascularization

Neovascularization plays an essential part in the progression of several diseases as well as recovery processes such as angiogenesis-guided neurogenesis after a spinal cord injury. To visualize and quantify neovascularization in an experimental setup, it is desirable to apply a noninvasive, repeatable, and harmless technique. Here, we apply a newly developed ultrasound-based technique to construct angiographies and quantify neovascularization in the regenerating spinal cord of a regeneration competent animal model, the Mexican axolotl. We measured vessel volume fraction prior to the induction of contusion and transection spinal cord injury and repeated this measurement directly after injury and at 3, 6, 12, and 63 days after injury. Although neither of the injury types resulted in statistically significant differences in vessel volume fraction relative to sham-operated animals, there was a statistically significant increase in neovascularization over time in all groups. Additionally, vessel volume fraction at the final time point (63 days after injury) was quantified with micro-CT imaging after vascular perfusion with a contrast agent, confirming no statistically significant difference in neovascularization between injury types. Ex vivo vessel volume fraction measured by micro-CT was significantly different from the in vivo ultrasound-based measurement at the same time point. This is likely a result of incomplete vascular perfusion with the contrast agent before micro-CT imaging, which was supported by subsequent histological evaluation. In summary, the results suggest that the ultrasound-based angiographic procedure, we demonstrate here, is applicable to visualize and quantify neovascularization in a noninvasive and harmless fashion in longitudinal experiments circumventing the limitations of contrast agent-dependent techniques.

Evaluating operator’s organ dose and effective dose according to the lead equivalent of radiation protection devices in performing angiography and interventional procedures

Evaluating operator’s organ dose and effective dose according to the lead equivalent of radiation protection devices in performing angiography and interventional procedures

Contrast-induced encephalopathy and permanent neurological deficit following cerebral angiography: A case report and review of the literature.

Contrast-induced encephalopathy (CIE) is an uncommon complication associated with contrast exposure during angiographic procedures that is usually transient but occasionally leads to permanent complications or death. Due to the low incidence of CIE, there are still insufficient reports. This study was used to summarize the clinical features of CIE through a case report and systematic review. We summarized and reviewed 127 patients with CIE, and we found that the total incidence of CIE between men and women had no difference (49.61 and 50.39%, respectively), but the average age in female patients with CIE was older than that in male patients (62.19 and 58.77 years, respectively). Interestingly, the incidence of female patients with CIE in the poor prognosis group was significantly higher than that in the good prognosis group (62.50 and 36.51%, respectively), and the average age of these female patients in the poor prognosis group was younger than that in the good prognosis group (61.39 and 62.82 years, respectively). The contrast medium types were mainly nonionic (79.69 and 73.02%, respectively) and low-osmolar (54.69 and 71.43%, respectively) in both groups. Importantly, the total contrast media administrated in patients with poor prognoses was greater than that administrated in patients with good prognoses (198.07 and 188.60 ml, respectively). In addition, comorbidities in both groups included hypertension (55.91%), diabetes mellitus (20.47%), previous contrast history (15.75%), renal impairment (11.81%), and hyperlipidemia (3.15%). The percentage of patients with cerebral angiography was significantly higher in the poor prognosis group than that in the good prognosis group (37.50 and 9.52%, respectively), whereas the percentage of patients with coronary angiography in both groups had the opposite results (35.94 and 77.78%, respectively). In conclusion, CIE may not always have a benign outcome and can cause permanent deficits. Female gender, younger age, the higher dose of contrast medium, and the procedure of cerebral angiography may be related to the patient's poor prognosis.

Transradial access for neurointerventional procedures: A practical approach.

Transradial approach (TRA) is a new technique proposed for performing cerebral angiography and neuro-interventional procedures. In this article, we sought to provide a step-by-step guide for carrying out a diagnostic cerebral angiography using this approach and summarize our center's experience. Records of patients since January 2020 were investigated, and data on demographic indices, reports of the procedures, outcomes, and complications were extracted. Then, these data were used to develop a step-by-step instruction for TRA cerebral angiography. Two hundred eighty-nine patients matched our eligibility criteria with a mean age of 50 years and a female-to-male ratio of 1.18. Overall, TRA was carried out successfully for 97.2% (281 patients). In case TRA failed, transfemoral approach was considered for the procedure. Three minor complications (two vasospasm and one small hematoma) and two major complications (one pseudoaneurysm of the radial artery and one radial artery avulsion) were observed. This article covers challenges a neurointerventionalist may face during a diagnostic cerebral angiography using TRA. Furthermore, our findings indicated that cerebral angiography with TRA might be performed safely and with a great success rate.

On‐Desk Model‐Based Study for Evaluating the Effect of Squeezing the Arteries in the Forearm on the Bioimpedance and Pressure of Blood

Background. Today, central aortic pressure (CAP) is measured through the invasive procedure of angiography. The only feasible alternative is applanation tonometry, requiring experienced staff to perform reliable measurements. The method of measuring the electrical bioimpedance (EBI) from the wrist gives promising results in estimating the CAP. However, the origin of the EBI data, its quality, and approaches to acquiring the signal are still vague. This study is aimed at determining the dependency of EBI of blood on the diameter, branching, and hindering the blood flow by squeezing the vessel. Methods. An on‐desk hydraulic and mechanical pipe system that imitates the arterial tree in the forearm with the modulated flow of saline solution to imitate the pulsating blood was constructed. The setup was verified in the simulation model. The flexible and rigid pipes were squeezed at selected locations of radial and ulnar arteries, and the superficial palmar arc and the pressure with impedance were measured. Results. The multifaceted effect of squeezing the selected locations of arteries in the forearm on the measured EBI and pressure was verified. The effect of arterial stiffening was verified, revealing a very strong inverse correlation of the time‐varying impedance (ΔZ(t)) of rigid pipe compared to the measured data of the wrist. Conclusion. To gain the highest magnitude of ΔZ(t), our research suggests applying pressure on the radial artery and measuring the EBI of the ulnar artery. Our results propose physiology‐based suggestions to increase the sensitivity of measured EBI of the pulse wave, constituting a base for designing novel wearable monitoring devices and algorithms for CAP estimation.

REBOA in pancreatic bleeds

Background: Late post-pancreatectomy haemorrhage (PPH) can be lethal. Surgical options of proximal and distal control whilst present, are not ideal. With the advent of angiographic procedures, these may become the mainstay resuscitative strategy. We present our experience with endovascular aortic occlusion and angiography.

Prevalence and Angiographic Characteristics of Coronary Artery Ectasia among Patients with Coronary Artery Disease: A Retrospective Analysis between 2014 and 2022.

Coronary artery ectasia (CAE) is defined as segmental dilatation with a diameter of 1.5-fold greater than that of an adjacent normal segment. Whether CAE is a unique clinical finding or results from other clinical entities remains to be determined. The purpose of the study was to investigate the prevalence, and clinical and angiographic characteristics of CAE in patients with coronary artery disease (CAD). Among the 8,845 coronary angiograms reviewed between the years 2014 and 2022, 142 patients had CAE yielding a detection rate of 4.9% among 2,870 CAD angiograms, and 28 patients had isolated CAE showing a detection rate of 0.32% (28/8,845) among total coronary angiography procedures. Overall, the incidence of CAE was 1.92% (170/8,845). The most commonly affected coronary artery by ectasia was the right coronary artery (RCA) (46.28%) among CAE coexisting with CAD cohort. The proportion of obesity, family history of CAD, and the proportion of hyperlipidemia in CAD patients who had ectasia were significantly higher than that in CAD patients who did not have ectasia (P < 0.05). In conclusion, CAE is an uncommon finding in coronary angiography, most commonly affecting the RCA. The obesity, family history of CAD, and the coexistence of hyperlipidemia were independent variables associated with CAE in CAD patients.

Analysis of Coronary Angiography and Revascularization Rates Made Over 5 Years in Public Institutions in Türkiye.

Coronary angiography is currently the gold standard anatomic imaging method used to diagnose obstructive epicardial coronary artery disease. In patients with critical coronary stenosis, surgical or percutaneous revascularization is provided. Normal coronary artery ratio in coronary angiography is an indirect indicator of patient selection quality. The aim of our study is to evaluate the efficiency of coronary angiography by examining the revascularization rates according to years in patients who underwent coronary angiography. Revascularization rates will be determined by analyzing retrospectively the number of patients who underwent coronary angiography in our country between 2016 and 2021 and were revascularized interventionally or surgically. The number of patients who underwent percutaneous, surgical, and total revascularization were proportioned to the number of coronary angiography, and their percentages were determined. From 2016 to 2019, there was a continuous increase in the number of coronary angiography. In 2020, the lowest coronary angiography numbers (n = 222.159) of the last 6 years were seen with the effect of the COVID-19 pandemic. In 2021, it was observed that the number of coronary angiography increased again with the relaxation of pandemic measures and the approaching of hospital admissions to old levels. It is seen that revascularization is performed in up to one-third of the patients who underwent coronary angiography. Similar to the rest of the world, revascularization rates as a result of coronary angiography procedures performed in our country are low. With this result, it should not be concluded that coronary angiography is not used effectively; on the contrary, the efficiency of coronary angiography can be increased by more effective use of noninvasive tests.

THE ROLE OF CHEST CT ANGIOGRAPHY AS A DIAGNOSTIC TOOL AND ROAD MAP FOR THE MANAGEMENT OF RASMUSSEN’S ANEURYSM: A CASE REPORT

Rasmussen’s aneurysm is a pulmonary artery pseudoaneurysm, secondary to the invasion of granular tissues to the pulmonary artery wall, causing massive hemoptysis. A 39-year-old male, with a history of pulmonary TB presented with massive hemoptysis, persistent cough, and dyspnea. Chest X-ray and Chest CT depicted active pulmonary tuberculosis and a co-infection with aspergillosis in the form of aspergilloma. Chest CT angiography (CTA) showed narrow-necked Rasmussen’s aneurysm with the feeding artery coming from the pulmonary artery of the apicoposterior segment and the systemic artery from the left thyrocervical trunk branch and left bronchial artery. Fluoroscopy-guided transarterial embolization with polyvinyl alcohol (PVA) and gel foam was performed from the left bronchial artery and thyrocervical trunk branch followed by transcatheter embolization with glue insertion via the pulmonary artery in the aneurysmal site. After the procedures the embolic agent completely filled the aneurysm and there were no complaints of hemoptysis during the follow-up. Appropriate chest CT angiography procedures can help diagnose Rasmussen’s aneurysm and become a road map for embolization. Transarterial catheter embolization from bronchial or non-bronchial systemic artery and pulmonary artery can be used as the treatment modality of choice for Rasmussen’s aneurysm in pulmonary tuberculosis with aspergillosis co-infection in the form of aspergilloma.