Angiography For Detection Research Articles

Differences in intracranial atherosclerosis plaque between posterior circulation and anterior circulation on high-resolution magnetic resonance imaging: A systematic review and meta-analysis

ObjectiveThe clinical characteristics and mechanisms of stroke caused by anterior circulation atherosclerotic plaques (ACAPs) and posterior circulation atherosclerotic plaques (PCAPs) are distinct. We aimed to compare the differences in vulnerability, morphology, and distribution between ACAPs and PCAPs based on hign-resolution magnetic resonance imaging (HR-MRI). Materials and MethodsThe PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang database were retrieved from inception through May 2023. Meta-analysis was performed by R 4.2.1 software. The quality of the literature was assessed by the Agency for Healthcare Research and Quality (AHRQ). Subgroup analysis was conducted to explore the heterogeneity of the pooled results. ResultsThere were a total of 13 articles, including 1194 ACAPs and 1037 PCAPs. The pooled estimates demonstrated that the incidence of intraplaque hemorrhage in the PCAPs was higher (OR 1.72, 95%CI 1.35-2.18). The plaque length (SMD 0.23, 95%CI 0.06-0.39) and remodeling index (SMD 0.29, 95%CI 0.14-0.44) of PCAPs were larger than those in ACAPs. However, there were no evident differences in significant enhancement or stenosis degree between the two groups. ConclusionThere were more unstable features in PCAPs, highlighting an elevated risk of recurrent ischemic stroke in the posterior circulation. Furthermore, PCAPs were prone to developing penetrating artery disease due to their wider distribution. Nevertheless, posterior circulation arteries exhibited a greater propensity for outward remodeling, which may lead treatment team to miss the optimal intervention stage by being overlooked on angiographic detection.

Coronary computed tomography angiographic detection of in-stent restenosis via deep learning reconstruction: a feasibility study.

Evaluation of in-stent restenosis (ISR), especially for small stents, remains challenging during computed tomography (CT) angiography. We used deep learning reconstruction to quantify stent strut thickness and lumen vessel diameter at the stent and compared it with values obtained using conventional reconstruction strategies. We examined 166 stents in 85 consecutive patients who underwent CT and invasive coronary angiography (ICA) within 3months of each other from 2019-2021 after percutaneous coronary intervention with coronary stent placement. The presence of ISR was defined as percent diameter stenosis ≥ 50% on ICA. We compared a super-resolution deep learning reconstruction, Precise IQ Engine (PIQE), and a model-based iterative reconstruction, Forward projected model-based Iterative Reconstruction SoluTion (FIRST). All images were reconstructed using PIQE and FIRST and assessed by two blinded cardiovascular radiographers. PIQE had a larger full width at half maximum of the lumen and smaller strut than FIRST. The image quality score in PIQE was higher than that in FIRST (4.2 ± 1.1 versus 2.7 ± 1.2, p < 0.05). In addition, the specificity and accuracy of ISR detection were better in PIQE than in FIRST (p < 0.05 for both), with particularly pronounced differences for stent diameters < 3.0mm. PIQE provides superior image quality and diagnostic accuracy for ISR, even with stents measuring < 3.0mm in diameter. With improvements in the diagnostic accuracy of in-stent stenosis, CT angiography could become a gatekeeper for ICA in post-stenting cases, obviating ICA in many patients after recent stenting with infrequent ISR and allowing non-invasive ISR detection in the late phase. • Despite CT technology advancements, evaluating in-stent stenosis severity, especially in small-diameter stents, remains challenging. • Compared with conventional methods, the Precise IQ Engine uses deep learning to improve spatial resolution. • Improved diagnostic accuracy of CT angiography helps avoid invasive coronary angiography after coronary artery stenting.

FITC-Labeled RGD Peptides as Novel Contrast Agents for Functional Fluorescent Angiographic Detection of Retinal and Choroidal Neovascularization.

The development of choroidal neovascularization (CNV) is a crucial factor in the pathophysiology and prognosis of exudative age-related macular degeneration (AMD). Therefore, the detection of CNV is essential for establishing an appropriate diagnosis and treatment plan. Current ophthalmic imaging techniques, such as fundus fluorescent angiography and optical coherence tomography, have limitations in accurately visualizing CNV lesions and expressing CNV activity, owing to issues such as excessive dye leakage with pooling and the inability to provide functional information. Here, using the arginine-glycine-aspartic acid (RGD) peptide's affinity for integrin αvβ3, which is expressed in the neovascular endothelial cells in ocular tissues, we propose the use of fluorescein isothiocyanate (FITC)-labeled RGD peptide as a novel dye for effective molecular imaging of CNV. FITC-labeled RGD peptides (FITC-RGD2), prepared by bioconjugation of one FITC molecule with two RGD peptides, demonstrated better visualization and precise localization of CNV lesions than conventional fluorescein dyes in laser-induced CNV rodent models, as assessed using various imaging techniques, including a commercially available clinical fundus camera (Optos). These results suggest that FITC-RGD2 can serve as an effective novel dye for the diagnosis of neovascular retinal diseases, including AMD, by enabling early detection and treatment of disease occurrence and recurrence after treatment.

Role of CT Angiography in Detection of Extracranial Carotid and Vertebral Artery Disease in Patients With Acutely Ruptured Intracranial Aneurysms

Introduction: Computed tomography (CT) and CT angiography are standard imaging modalities for suspected acute intracerebral hemorrhage due to ruptured intracranial aneurysms. In this clinical setting, several protocols of computed tomography and CT angiography may be implemented. The standard CT angiography protocol is limited to intracranial vessels. The extended protocol may also include carotid and vertebral arteries and the aortic arch.Objective: To define the CT angiography role in detection of extracranial carotid and vertebral artery disease and clinical significance of this method for patients with suspected acute intracerebral hemorrhages due to ruptured intracranial aneurysms.Materials and methods: The study included 275 neurosurgical patients with acute nontraumatic intracranial hemorrhages due to ruptured intracranial aneurysms who were treated in Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1 (Krasnodar, Russian Federation) from September 2017 to August 2020. Computed tomography and CT angiography were performed in all patients. The scanned area included both intracranial and extracranial arteries (an arch-to-vertex angiogram) to detect extracranial carotid and vertebral artery diseases such as stenoses, occlusions, tortuosity, and hypoplasia.Results: Atherosclerosis of internal carotid and vertebral arteries was diagnosed in 95 patients (34.5% of the total number of patients included in the study). In 13 (4.7%) patients these stenoses were hemodynamically significant. We identified a high frequency of tortuous carotid and vertebral arteries (122 cases, 44.3%) and vertebral artery hypoplasia (59 cases, 21.5%). The carotid and vertebral artery stenoses and congenital anomalies of vertebral arteries (however, not of carotid arteries) were associated with a higher incidence of unfavorable outcomes after endovascular treatment of intracranial aneurysms.Conclusions: The optimal CT angiography protocol for acute nontraumatic intracranial hemorrhage should focus on the arteries of the head and neck (up to the aortic arch). This protocol shows higher detection rate of concomitant anomalies of carotid and vertebral arteries. These findings are important for planning and successful performance of endovascular treatment for intracranial aneurysms.

DIAGNOSTIC ACCURACY OF CT CORONARY ANGIOGRAPHY.

Coronary Artery Disease (CAD) is an emerging and commonest type of heart disease resulting in morbidity and mortality globally. Coronary angiography is a diagnostic modality used to diagnose the coronary artery disease or the extent of blockage of coronary arteries. The multi-slice computed tomography (MSCT) technology such as 64-slice, 128-slice, 256-slice, and now 320-slice MSCT has produced a high diagnostic accuracy of CT coronary angiography. This prospective-cross sectional study was done in Department of Cardiology in Medanta, the Medicity, from November 2017 to December 2018 with the aim to evaluate the diagnostic accuracy of 256 slice CT coronary angiogram in measuring the percentage diameter stenosis compared to invasive angiography and to determine the sensitivity and specicity of CT coronary angiography in detection of coronary artery stenosis among symptomatic patients. A total of 60 patients presented with acute or chronic chest pain with risk for CAD were included. The mean age of the participants was 57.35±10.16 years and 88.3% participants were male and 11.7% participants were females. 56.6% participants had BMI &gt;25, 11.7% were alcoholic, 40% were smoker, 16.7% had diabetes and 38.3% had hypertension. The study concluded that CCTA should be considered initial test of choice in patients presenting with chest pain with low to intermediate probability of CAD because the time required for diagnosis is signicantly shorter, high sensitivity, specicity, PPV and NPV on per vessel and per segment basis, determination of LVEF and has the ability to rule out causes of atypical chest pain including pulmonary embolism and aortic dissection.

Diagnostic Value of Multidetector Computer Tomography Coronary Angiography in Detection of Coronary Artery Stenosis

Diagnostic Value of Multidetector Computer Tomography Coronary Angiography in Detection of Coronary Artery Stenosis

Are angiographic culprit lesions true? Disagreement between angiographic and optical coherence tomographic detection.

Are angiographic culprit lesions true? Disagreement between angiographic and optical coherence tomographic detection.

In Reply: Commentary: Value of 3-Dimensional Digital Subtraction Angiography for Detection and Classification of Intracranial Aneurysm Remnants After Clipping.

In Reply: Commentary: Value of 3-Dimensional Digital Subtraction Angiography for Detection and Classification of Intracranial Aneurysm Remnants After Clipping.

The Role Of Doppler Ultrasound, CT Angiography and Conventional Angiography in Detection of Peripheral Arterial Disease for CME credit September 2021

The Role Of Doppler Ultrasound, CT Angiography and Conventional Angiography in Detection of Peripheral Arterial Disease for CME credit September 2021

Comparison of multicolor scanning laser ophthalmoscopy and optical coherence tomography angiography for detection of microaneurysms\xa0in diabetic retinopathy

This study aimed to evaluate the usefulness of multicolor (MC) scanning laser ophthalmoscopy (MC-SLO) in detecting microaneurysm (MA) in eyes with diabetic retinopathy (DR). This was a retrospective cross-sectional study. Eyes with DR underwent fluorescein angiography (FA), MC-SLO, optical coherence tomography angiography (OCTA), and color fundus photography (CFP) were analyzed. The foveal region was cut in an 6 × 6 mm image and the number of MA in each image was counted by retina specialists to determine the sensitivity and positive predictive value. FA results were used as the ground standard. MAs were classified as those with early, late, or no dye leakage based on FA images. Fifty-four eyes of 35 patients with an average age of 64.5 ± 1.24 years were included. The sensitivity of MA detection was 37.3%, 15.3%, and 4.12% in MC-SLO, OCTA, and CFP, respectively (P < 0.01 in each pair).The positive predictive value was 66.4%, 46.4%, and 27.6% in MC, OCTA, and CFP, respectively (P < 0.01 in each pair). Sensitivity for MAs with early leakage was 36.4% in MC-SLO, which was significantly higher than 4.02% in OCTA. MC-SLO was more useful in detecting MA in eyes with DR than OCTA.

The Role of Doppler Ultrasound, CT Angiography, and Conventional Angiography in Detection of Peripheral Arterial Disease

The purpose of this study is to analyze how accurate duplex ultrasonography using color Doppler and computed tomography (CT) angiography are in detection of peripheral arterial disease (PAD) in comparison with the Gold Standard of digital subtraction angiography (DSA). This is a single-center prospective, analytical study done on patients with symptoms of PAD referred to the Department of Radiodiagnosis of Medical Trust Hospital (n = 53). All patients were imaged with color Doppler, CT angiography, and DSA. The peak systolic velocity (PSV) ratio was calculated by Doppler ultrasound, and the percentage stenosis for the same vascular segments was calculated using CT angiography and DSA. To test the statistical significance between the results, chi-square test was used. A P value &lt;.05 indicates statistical significance. The PSV ratio for each grade—normal (&lt;1.5), mild (1.5-2.8), moderate (2.9-4.9), and severe (≥5)—and the percentage of stenosis for each grade observed on CT angiography—normal (&lt;20% stenosis), mild (20%-49% stenosis), moderate (50%-74% stenosis), severe (75%-99% stenosis), and total occlusion (100% stenosis)—were found to be highly sensitive and specific with good positive predictive value, negative predictive value, and accuracy level when compared with DSA with narrow confidence intervals for each range. The P value was &lt;.001 for both color Doppler and CT angiography. Computed tomography angiography can be an effective tool as an alternative to DSA for gradation of stenosis if the artifacts resulting from vascular calcification can be avoided. Duplex ultrasonography can be utilized for gradation of stenosis by using the value of PSV ratio and spectral pattern together. However, it can only act as an adjunct to CT angiography because it is incapable of imaging the full length of the arterial segments in one frame.

Comparison of swept-source versus spectral-domain optical coherence tomography angiography for detection of macular neovascularization

PurposeTo compare swept-source (SS) versus spectral-domain (SD) optical coherence tomography angiography (OCTA) for the detection of macular neovascularization (MNV).MethodsIn this prospective cohort study, 72 eyes of 54 patients with subretinal hyperreflective material (SHRM) and/or pigment epithelial detachment (PED) on OCT possibly corresponding to MNV in at least one eye were included. OCTA scans were acquired using two devices, the PLEX Elite 9000 SS-OCTA and the Spectralis SD-OCTA. Fluorescein angiography (FA) was used as reference. Two graders independently evaluated en face OCTA images using a preset slab as well as a manually modified slab, followed by a combination of en face and cross-sectional OCTA.ResultsSensitivity (specificity) for the automated slabs was 51.7% (93.0%) for SS-OCTA versus 58.6% (95.3%) for SD-OCTA. Manual modification of segmentation increased sensitivity to 79.3% for SS-OCTA but not for SD-OCTA (58.6%). The combination of en face OCTA with cross-sectional OCTA reached highest sensitivity values (SS-OCTA: 82.8%, SD-OCTA: 86.2%), and lowest number of cases with discrepancies between SS-OCTA and SD-OCTA (4.2%). Fleiss kappa as measure of concordance between FA, SS-OCTA, and SD-OCTA was 0.56 for the automated slabs, 0.60 for the manual slabs, and 0.73 (good agreement) for the combination of en face OCTA with cross-sectional OCTA. Concordance to FA was moderate for the automated slabs and good for manual slabs and combination with cross-sectional OCTA of both devices.ConclusionBoth devices reached comparable results regarding the detection of MNV on OCTA. Sensitivity for MNV detection and agreement between devices was best when evaluating a combination of en face and cross-sectional OCTA.

Reliability of Optical Coherence Tomography Angiography in Detection of Early Hydroxychloroquine Toxicity

Background: Chloroquine is an antimalarial drug, while hydroxychloroquine is an analogue of chloroquine. Hydroxychloroquine (HCQ) is used to treat autoimmune diseases in addition to malaria. They have toxic effects on retina. Different screening protocols were described to detect HCQ toxicity. Objective: The aim of the current work was to study the ability of optical coherence tomography angiography (OCTA) to detect early retinal changes that may occur after HCQ treatment in patients with rheumatoid arthritis. Patient and Methods: This prospective cross-sectional study included a total of 40 eyes of 20 patients who were newly or previously prescribed HCQ for rheumatoid arthritis, recruiting from the Department of Ophthalmology, Al-Zahraa University Hospital. This study was conducted between May 2018 to Dec 2019. OCTA imaging was performed via Angiovue software. Results: The superficial whole vascular density, superficial parafoveal vascular density, superficial perifoveal vascular density, deep whole vascular density, deep parafoveal vascular density, and deep perifoveal vascular density were thinner in treatment groups compared to the control group (p < 0.05). Conclusion: OCTA could be a beneficial tool for screening of HCQ retinal affection. It could detect the decrease in the deep capillary plexus at the parafoveal and perifoveal regions in patients who were receiving HCQ treatment.

Ventilation-Perfusion Scan Is Superior to CT Pulmonary Angiography in Detection of Chronic Thromboembolic Pulmonary Hypertension in SCD Adults

▪Background: Pulmonary hypertension (PH) in adults with sickle cell disease (SCD) is associated with significant morbidity and early mortality. Venous thromboembolism (VTE) is common in SCD and affects about 25% of SCD adults. Although not generally considered a major cause of PH, chronic thromboembolic pulmonary hypertension (CTEPH) has been noted, and is probably more common than realized in patients with SCD. National guidelines recommend that CTEPH should be excluded in any patient suspected to have PH. Imaging techniques, including ventilation-perfusion (V/Q) scintigraphy, multidetector CT pulmonary angiography (CTPA), high-resolution CT (HRCT), pulmonary digital subtraction angiography (DSA), and magnetic resonance angiography have been used in identifying CTEPH as the cause of PH. Several studies have shown that V/Q scintigraphy is able to distinguish patients with CTEPH from other causes of PH, to the extent that normal V/Q scintigraphy can comfortably rule out CTEPH. However, data on V/Q and associated outcomes on SCD are limited. In this study, we report a retrospective analysis of V/Q scintigraphy findings and CTPA for assessing PH as validated by right heart catherization. We also report associated outcomes of the V/Q findings with prospectively collected data in the adult SCD patients.Methods: This study was approved by the Institutional Review Board at the National Institutes of Health (NIH), and all subjects provided written informed consent to one or more studies.A total of 142 consecutive patients, (83 women, aged 40.1 ± 13.7 years, HbSS 124 (87%) suspected of having PH were prospectively enrolled (Table 1). All patients underwent V/Q scanning, echocardiography (ECHO), six-minute walk testing (6MWT); 52 patients underwent CTPA, and 63 patients had right heart catheterization (RHC) performed. Interpretation of V/Q images was based on the refined Pulmonary Embolism Diagnosis criteria. High-probability and intermediate-probability V/Q scan findings were considered to be positive or abnormal, and very low, low-probability/normal V/Q scan findings were considered negative or normal V/Q.Results: V/Q scan was abnormal in 58 (40.8%) patients (high probability and intermediate probability in 26 (18.3%), 32 (22.5%), respectively), and was low probability/normal in 84 (59.2%) patients (Table 1). CTPA was positive for PE in 17 (32.7%) patients. Patients with positive CTPA were more likely to have abnormal V/Q [ abnormal V/Q 14 (82.4%) vs. normal V/Q 3(17.6); p=0.032], but in those with negative CTPA (n=35), V/Q was abnormal in 18 (51.4%) (Table 2). RHC confirmed PH (mean pulmonary artery pressure (mPAP) ≥25mmHg) in 45/63 patients, of which 33 (73.3%) had abnormal V/Q compared to 12 (26.6%) with normal V/Q scans, (p=0.0001). Among those with no PH by RHC (n=18), only one patient showed abnormal and 17 normal V/Q (5.6% vs 94.4%, respectively, (p<0.001). Thirty-two patients had a complete dataset of V/Q, CTPA and RHC, and clearly there was greater concordance of results between RHC with V/Q than CTPA (Table 3). Subjects with SCD and abnormal V/Q demonstrated significantly worse hemodynamic severity (mPAP=35.95 ± 9.20 vs.24.8± 12.09 mmHg, p<0.001; right atrial pressure= 9.59± 4.53 vs. 9.59± 4.53mmHg, p<0.001; transpulmonary gradient 21.8 ± 10.4 vs. 12.16± 11mmHg, p=0.001, and pulmonary vascular resistance=238.3 ± 135 vs.120.5 ± 134.9 dynes.s.cm-5, p=0.001 ) and abnormal cardiopulmonary markers of clinical severity compared to those with a normal V/Q group, including higher TRV (3.5±0.6 vs. 3±0.5 m/s, p=0.01) and poor exercise capacity (6MWD 379.7±117.3 vs. 438.8±115.5m, p<0.001). Over a median follow-up of 6 years with a maximum follow-up of 15 years, total of 34 deaths were observed (Fig 1). The all-cause mortality was higher in the abnormal V/Q 19 (56%) group compared to those with normal V/Q 15 (44%) patients (log-rank test, p<0.001, Hazard Ratio=2.54).Conclusion: Using RHC as the benchmark, our data demonstrates that V/Q scan is superior in detecting CTEPH in adults with SCD. Additionally, abnormal V/Q scan is associated with worse hemodynamics by RHC, poor functional capacity and increased mortality. We recommend frequent use of V/Q in the evaluation of dyspnea in adults with SCD as confirmation of CTEPH has important implications in management. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Micro-CT-Based Quantification of Extracted Thrombus Burden Characteristics and Association With Angiographic Outcomes in Patients With ST-Elevation Myocardial Infarction: The QUEST-STEMI Study

Background: Angiographic detection of thrombus in STEMI is associated with adverse outcomes. However, routine thrombus aspiration failed to demonstrate the anticipated benefit. Hence, management of high coronary thrombus burden remains challenging. We sought to assess for the first time extracted thrombotic material characteristics utilizing micro-computed tomography (micro-CT).Methods: One hundred thirteen STEMI patients undergoing thrombus aspiration were enrolled. Micro-CT was undertaken to quantify retrieved thrombus volume, surface, and density. Correlation of these indices with angiographic and electrocardiographic outcomes was performed.Results: Mean aspirated thrombus volume, surface, and density (±standard deviation) were 15.71 ± 20.10 mm3, 302.89 ± 692.54 mm2, and 3139.04 ± 901.88 Hounsfield units, respectively. Aspirated volume and surface were significantly higher (p < 0.001) in patients with higher angiographic thrombus burden. After multivariable analysis, independent predictors for thrombus volume were reference vessel diameter (RVD) (p = 0.011), right coronary artery (RCA) (p = 0.039), and smoking (p = 0.027), whereas RVD (p = 0.018) and RCA (p = 0.019) were predictive for thrombus surface. Thrombus volume and surface were independently associated with distal embolization (p = 0.007 and p = 0.028, respectively), no-reflow phenomenon (p = 0.002 and p = 0.006, respectively), and angiographically evident residual thrombus (p = 0.007 and p = 0.002, respectively). Higher thrombus density was correlated with worse pre-procedural TIMI flow (p < 0.001). Patients with higher aspirated volume and surface developed less ST resolution (p = 0.042 and p = 0.023, respectively).Conclusions: Angiographic outcomes linked with worse prognosis were more frequent among patients with larger extracted thrombus. Despite retrieving larger thrombus load in these patients, current thrombectomy devices fail to deal with thrombotic material adequately. Further studies of novel thrombus aspiration technologies are warranted to improve patient outcomes.Clinical Trial Registration: QUEST-STEMI trial ClinicalTrials.gov number: NCT03429608 Date of registration: February 12, 2018. The study was prospectively registered.

Efficacy of optical coherence tomography and fundus fluorescein angiography in detection of diabetic macular edema

Purpose: Significance of clinical DME in an up becoming capital nation of diabetes mellitus in world has socio-economic effect due to VTDR is identified as the major cause of irreversible blindness in DR subjects in all age groups. Therefore, the need for reliable, safe and immediate detection of DME is a need for prevention of the disease & related socio economic burden. The study was to compare the diagnostic potential of two commonly established diagnostic instruments i.e.-SD-OCT & FFA for the detection of DME. Materials and Methods: A prospective study with purposively sampling technique was carried on 308 eyes of 154 type II DM patients to compare the detection potential between two popular retinal diagnostic techniques, SD-OCT a non-invasive technique versus FFA invasive method for DME. The standard parameters such as focal macular edema, diffuse macular edema and mixed edema with cystoid type were evaluated with FFA. Subsequently DME classification with presence of intraretinal edema, sub retinal fluid and mixed edema were diagnosed with SD-OCT for the same pool of patients. Clinical features in DME using reference ‘EDTRS’ scale of measurement. Results: Noninvasively 305 (99.1%) eyes were detected positive for various type of DME by SD-OCT while 282 (91.6%) eyes were detected positive by FFA. The prevalence of different types of DME such as cystoids, diffuse, focal and mixed was 7.8%, 13%, 7.1% and 63.7% respectively as diagnosed with FFA. Whereas, SRF, IR edema and mixed type was 4.9%, 3.6% and 90.6% respectively as diagnosed with SD-OCT. DME was not detected by FFA in 8.4% of eyes in overall study population. Whereas, SD-OCT was unable to detect DME in 0.9% of eyes. In our study overall performance of SD-OCT was better in detection of DME when compared to FFA. Conclusion: The present study showed the diagnostic potential and efficacy of SD-OCT over FFA in reliable and safe detection of DME in Type II Diabetic Mellitus patients was more and was easy and

Virtual reality adds value to analysis of aneurysms post-flow diversion, coiling, and clipping

Purpose: The purpose of this study was to measure sensitivity of virtual reality (VR) in detecting biomarkers of neurovascular remodeling suboptimally evaluated in digital subtraction angiography (DSA) of treated unruptured, intracranial aneurysms. Methods: The sensitivity of virtual reality and digital subtraction angiography in detection of neurovascular biomarkers in aneurysms treated with flow diversion, coiling, and clipping were evaluated. Validated grading scales were integrated into a standardized rating platform. The respective novel and conceptual measures of minimal imaging important difference (MIID) and number needed to image (NNI) were calculated for each biomarker. Results: In flow diversion, coiling, and clipping, minimal imaging important difference and number needed to image were associated with virtual reality in detection of abnormal biomarkers, with the exception of stasis phase associated with digital subtraction angiography. Number needed to image was associated with flow diversion stent stenosis (RR: 7.00, 95% CI 0.37 to 131.97; OR: 7.46, 95% CI 0.38 to 148.49). Minimal imaging important difference was greatest in residual aneurysm filling (25%±66, 95% CI) in flow diversion and Meyer score in coiling (42.5%±17.69, 95% CI) and clipping (22.2%±13.58, 95% CI). Regression models demonstrated minimal imaging important difference and number needed to image shared a significant correlation (R20.99, 95% CI, p&lt;0.001). Conclusion: Virtual reality adds value to digital subtraction angiography in evaluation of aneurysms treated with flow diversion, coiling, and clipping. Larger, prospective studies are warranted to increase statistical power and validate clinical significance.

Evaluation of Intravital Ranibizumab on Proliferative Diabetic Retinopathy with Macular Edema by Optical Coherence Tomography Angiography

Purpose: To evaluate the effect of ranibizumab by Optical Coherence Tomography Angiography (OCTA)in proliferative diabetic retinopathy (PDR) with macular edema and to evaluate the role of Swept Source Optical Coherence Tomography Angiography in detection and characterization of new vessels at the disc (NVD) and new vessels elsewhere (NVE). Subjects and Method: The study included patients with proliferative diabetic retinopathy (PDR) and clinically significant diabetic macular edema. Patients with central macular thickness (CMT) above 300 μm underwent intravitreal injection of 0.5 mg Ranibizumab&amp; those having CMT below 300μm had laser treatment. Results: The study was conducted on 50 cases with proliferative diabetic retinopathy with macular edema There was significant increase in best corrected visual acuity (BCVA) across time of treatment. Mean (±SD) BCVA at diagnosis, at 1monthat 3 month were 9.1±0.1, 0.8±0.1, 0.7±0.2. respectively (p&lt;0.001) Central macular thickness (CMT); Area of neovascularization (ArNV); Exuberant Vascular Proliferation (EVP)showed significant decrease across time of treatment, Conclusion: ranibizumab injections are a safe and effective alternative to Pan retinal photocoagulation for the management of PDR. OCTA is useful to monitor different NVD subtypes, their development, and the efficacy of treatment regimens as well as to define new vessel morphological details. Small scan size delineates minute morphology of NVD and misses extension of lesions beyond disc margin, while larger scan size masks fine details.

Surveillance for cardiac allograft vasculopathy: Practice variations among 50 pediatric heart transplant centers

Coronary allograft vasculopathy (CAV) is a leading cause of mortality after heart transplantation (HT) in children. Variation in CAV screening practices may impact detection rates and patient outcomes. Among 50 Pediatric Heart Transplant Society (PHTS) sites from 2001 to 2016, coronary evaluations were classified as angiography or non-invasive testing, and angiograms were designated as routine or symptom based. CAV detection rates stratified by routine vs symptom-based angiograms were calculated. Freedom from CAV and mortality after CAV diagnosis, stratified by study indication, were calculated. A total of 3,442 children had 13,768 coronary evaluations; of these, 97% (n = 13,012) were for routine surveillance, and only 3% (n = 333) were for cause. Over the study period, CAV was detected in 472 patients (14%). Whereas 58% (n = 29) of PHTS sites evaluate by angiography alone, 42% reported supplementing with a non-invasive test, although only 423 non-invasive studies were reported. Angiographic detection of CAV was higher for symptom-based testing than for routine testing (29% vs 4%, p < 0.0001), although routine testing identified a majority of cases (88%; n = 414). The 10-year freedom from CAV was 77% overall. Once CAV is detected, 5-year graft survival was 58%, with lower survival for patients diagnosed after symptoms angiogram than after routine angiogram (30% vs 62%; p < 0.0001). Development of a robust model for CAV risk should allow low-risk patients to undergo less frequent invasive angiography without adverse impact on CAV detection rates or outcomes.

Erratum. Incidence, classification, and treatment of angiographically occult intracranial aneurysms found during microsurgical aneurysm clipping of known aneurysms.

OBJECTIVE During the microsurgical clipping of known aneurysms, angiographically occult (AO) aneurysms are sometimes found and treated simultaneously to prevent their growth and protect the patient from future rupture or reoperation. The authors analyzed the incidence, treatment, and outcomes associated with AO aneurysms to determine whether limited surgical exploration around the known aneurysm was safe and justified given the known limitations of diagnostic angiography. METHODS An AO aneurysm was defined as a saccular aneurysm detected using the operative microscope during dissection of a known aneurysm, and not detected on preoperative catheter angiography. A prospective database was retrospectively reviewed to identify patients with AO aneurysms treated microsurgically over a 20-year period. RESULTS One hundred fifteen AO aneurysms (4.0%) were identified during 2867 distinct craniotomies for aneurysm clipping. The most common locations for AO aneurysms were the middle cerebral artery (60 aneurysms, 54.1%) and the anterior cerebral artery (20 aneurysms, 18.0%). Fifty-six AO aneurysms (50.5%) were located on the same artery as the known saccular aneurysm. Most AO aneurysms (95.5%) were clipped and there was no attributed morbidity. The most common causes of failed angiographic detection were superimposition of a large aneurysm (type 1, 30.6%), a small aneurysm (type 2, 18.9%), or an adjacent normal artery (type 3, 36.9%). Multivariate analysis identified multiple known aneurysms (odds ratio [OR] 3.45, 95% confidence interval [CI] 2.16-5.49, p < 0.0001) and young age (OR 0.981, 95% CI 0.965-0.997, p = 0.0226) as independent predictors of AO aneurysms. CONCLUSIONS Meticulous inspection of common aneurysm sites within the surgical field will identify AO aneurysms during microsurgical dissection of another known aneurysm. Simultaneous identification and treatment of these additional undiagnosed aneurysms can spare patients later rupture or reoperation, particularly in those with multiple known aneurysms and a history of subarachnoid hemorrhage. Limited microsurgical exploration around a known aneurysm can be performed safely without additional morbidity.