Arteriographic Findings Research Articles

Magnetic resonance arteriography findings in the early post-carotid endarterectomy period : Stuckey SL, Gilford EJ, Smith PJ, Kean M (Department of Radiology, St. Vincent's Hospital, Fitzroy, Vic. 3065, Australia). Australasian Radiol 1995;39:350–355

Magnetic resonance arteriography findings in the early post-carotid endarterectomy period : Stuckey SL, Gilford EJ, Smith PJ, Kean M (Department of Radiology, St. Vincent's Hospital, Fitzroy, Vic. 3065, Australia). Australasian Radiol 1995;39:350–355

Intraoperative Ventricular Tachycardia Responsive to Adenosine

Intraoperative Ventricular Tachycardia Responsive to Adenosine

Clinical significance of vascular endothelial growth factor and basic fibroblast growth factor gene expression in liver tumor

Hepatocellular carcinoma (HCC) is a typical hypervascular tumor. However, the relationship between the vascularity of HCC and the expression of angiogenic factors has not been investigated. In addition, no detailed studies have examined the possible involvement of angiogenic factors in the grade of malignancy of HCC. The aim of this study was to determine which angiogenic factors regulate tumor angiogenesis and contribute to the invasive ability of liver tumors, especially of HCC. Northern blot analysis was used to examine the transcriptional expression of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (FGF), and acidic FGF in resected surgical specimens (20 HCC and 9 metastatic liver tumors). Correlations between messenger RNA (mRNA) expression and arteriographic findings, as well as histopathological findings, were evaluated. Immunohistochemistry was performed to identify the localization of cells expressing VEGF in HCC. Higher levels of VEGF mRNA were observed in 12 of 20 HCC and 2 of 9 metastatic liver tumors than in corresponding nontumorous tissues. The degree of VEGF mRNA expression was significantly correlated with the intensity of tumor staining in angiograms (P <.01). On immunohistochemical observation, VEGF protein was intensely detected in HCC cells. Furthermore, basic FGF mRNA was detected in 9 of 20 HCC and was related to the capsular infiltration of cancer cells (P <.05). In contrast, no significant difference was observed in the very low levels of acidic FGF mRNA found in the tumorous and nontumorous portions of the liver. In conclusion, these results suggest that VEGF contributes to angiogenesis of liver tumors, whereas basic FGF may be involved in the invasion of HCC into the surrounding tissues.

Clinical significance of vascular endothelial growth factor and basic fibroblast growth factor gene expression in liver tumor

Hepatocellular carcinoma (HCC) is a typical hypervascular tumor. However, the relationship between the vascularity of HCC and the expression of angiogenic factors has not been investigated. In addition, no detailed studies have examined the possible involvement of angiogenic factors in the grade of malignancy of HCC. The aim of this study was to determine which angiogenic factors regulate tumor angiogenesis and contribute to the invasive ability of liver tumors, especially of HCC. Northern blot analysis was used to examine the transcriptional expression of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (FGF), and acidic FGF in resected surgical specimens (20 HCC and 9 metastatic liver tumors). Correlations between messenger RNA (mRNA) expression and arteriographic findings, as well as histopathological findings, were evaluated. Immunohistochemistry was performed to identify the localization of cells expressing VEGF in HCC. Higher levels of VEGF mRNA were observed in 12 of 20 HCC and 2 of 9 metastatic liver tumors than in corresponding nontumorous tissues. The degree of VEGF mRNA expression was significantly correlated with the intensity of tumor staining in angiograms (P &lt;.01). On immunohistochemical observation, VEGF protein was intensely detected in HCC cells. Furthermore, basic FGF mRNA was detected in 9 of 20 HCC and was related to the capsular infiltration of cancer cells (P &lt;.05). In contrast, no significant difference was observed in the very low levels of acidic FGF mRNA found in the tumorous and nontumorous portions of the liver. In conclusion, these results suggest that VEGF contributes to angiogenesis of liver tumors, whereas basic FGF may be involved in the invasion of HCC into the surrounding tissues.

Clinical significance of vascular endothelial growth factor and basic fibroblast growth factor gene expression in liver tumor

Hepatocellular carcinoma (HCC) is a typical hypervascular tumor. However, the relationship between the vascularity of HCC and the expression of angiogenic factors has not been investigated. In addition, no detailed studies have examined the possible involvement of angiogenic factors in the grade of malignancy of HCC. The aim of this study was to determine which angiogenic factors regulate tumor angiogenesis and contribute to the invasive ability of liver tumors, especially of HCC. Northern blot analysis was used to examine the transcriptional expression of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (FGF), and acidic FGF in resected surgical specimens (20 HCC and 9 metastatic liver tumors). Correlations between messenger RNA (mRNA) expression and arteriographic findings, as well as histopathological findings, were evaluated. Immunohistochemistry was performed to identify the localization of cells expressing VEGF in HCC. Higher levels of VEGF mRNA were observed in 12 of 20 HCC and 2 of 9 metastatic liver tumors than in corresponding nontumorous tissues. The degree of VEGF mRNA expression was significantly correlated with the intensity of tumor staining in angiograms (P <.01). On immunohistochemical observation, VEGF protein was intensely detected in HCC cells. Furthermore, basic FGF mRNA was detected in 9 of 20 HCC and was related to the capsular infiltration of cancer cells (P <.05). In contrast, no significant difference was observed in the very low levels of acidic FGF mRNA found in the tumorous and nontumorous portions of the liver. In conclusion, these results suggest that VEGF contributes to angiogenesis of liver tumors, whereas basic FGF may be involved in the invasion of HCC into the surrounding tissues. (Hepatology 1996 Mar;23(3):455-64)

A reassessment of Doppler pressure indices in the detection of arterial lesions in proximity penetrating injuries of extremities: a prospective study.

This prospective study assessed the role of Doppler pressure indices (Ankle-Brachial Index [ABI] or Brachial Brachial Index [BBI]) in the evaluation for occult arterial injury from penetrating proximity extremity trauma (PET). A total of 258 patients with 323 PETs were evaluated by physical examination and Doppler pressure (ABI/BBI) determination. An ABI/BBI of < 0.9 was considered abnormal. The findings were compared with those of arteriography in all patients. Eleven injuries (3.4%) found on arteriography were associated with normal indices. Five of these injuries were treated by repair (4 patients) or angiographic embolization of a bleeding vessel (1 patient), all in lesions proximal to the knee or elbow joints. The other six lesions were observed without intervention. All of the 29 injuries associated with abnormal indices had positive arteriographic findings. The 4 lesions that were treated operatively were proximal and the remaining 25, all with distal penetration, were observed without observation. As compared to angiography, Doppler indices yielded the following results: 283 true-negative, 11 false-negative, 29 true-positive, and 0 false-positive, for a sensitivity of 72.5%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 96%. These data suggest that Doppler indices should be an integral part of the physical examination and can screen patients with proximal injuries for further studies such as duplex sonography or arteriography.

Diffuse disorder of coronary artery vasomotility in patients with coronary spastic angina: Hyperreactivity to the constrictor effects of acetylcholine and the dilator effects of nitroglycerin

We examined the vasomotility of the entire epicardial coronary artery system in patients with and without coronary spastic angina. The coronary arteries of patients with variant angina are hyperreactive to diverse constrictor stimuli. It is unclear whether the abnormal responses to constrictive or dilative stimuli, or both, result from a localized or diffuse disorder in the coronary artery tree. Coronary artery diameter responses to intracoronary acetylcholine and nitroglycerin were examined at the proximal, middle and distal segments of three principal coronary arteries in 36 patients with coronary spastic angina without significant stenosis and in 12 young (< or = 30 years old) and 20 older control subjects (> 30 years old) with normal coronary arteriographic findings. In 10 patients with significant coronary stenosis, the responses of the prestenotic segments were also examined. In patients with coronary spastic angina, coronary spasm was induced in 23 left anterior descending, 13 left circumflex and 17 right coronary arteries by acetylcholine. Multivessel spasm was observed in 15 patients. Acetylcholine had a dilator effect on most segments in young control subjects and a mild constrictor effect in older control subjects and in patients with significant stenosis. Comparison of the responses to acetylcholine among groups demonstrated that the constrictor response of the artery with spasm was enhanced significantly and diffusely. That of the artery without spasm also tended to be enhanced. Coronary artery diameters after nitroglycerin did not differ in any segment among patients with coronary spastic angina and both control groups. In patients with coronary spastic angina, nitroglycerin significantly enhanced dilation in all segments of the artery with spasm compared with that observed in both control groups and in most segments of the artery without spasm. Patients with significant coronary stenosis had a reduced response compared with that in control subjects. Hyperreactive responses not only to the constrictor effects of acetylcholine, but also the dilator effects of nitroglycerin were detected diffusely in the epicardial coronary arteries of patients with coronary spastic angina. This finding indicates that a diffuse, not localized, disorder in vasomotility is involved in the pathogenesis of coronary spastic angina.

Adverse Prognosis of ST Depression on the Resting Electrocardiogram in Stable Patients Following Acute Myocardial Infarction

Background: The aim of this study was to analyze the characteristics of stable patients with resting ST segment depression on the resting electrocardiogram (ECG) following an acute ischemic event (i.e., infarction or unstable angina) to better understand its association with subsequent cardiac death and nonfatal infarction. The recent Multicenter Study of Myocardial Ischemia (MSMI) demonstrated that the resting ST segment depression had an independent prognostic value.Methods: We studied clinical features, noninvasive test results and coronary arteriography findings in 99 patients with ST depression on the resting ECG and 837 patients without ST segment depression with respect to endpoints of cardiac death and hospitalization for acute myocardial infarction or unstable angina.Results: Our results showed that patients with resting ECG ST depression were significantly older with a higher incidence of hypertension, angina, claudication, and tobacco use. ST depression on the resting ECG correlated closely with ST segment depression on the 24‐hour ambulatory ECG and the exercise ECG but not with redistribution on the thallium perfusion scan. Left ventricular diastolic pressure was higher and exercise duration less in patients with ST depression. Although not achieving statistical significance, patients with ST depression did show more extensive coronary disease and a lower ejection fraction.Conclusions: ECG ST depression was associated with cardiac death and nonfatal reinfarction over the follow‐up period only in patients originally admitted with an acute infarction but not in patients hospitalized for unstable angina. The reason for this appears to be an association of ST depression with increased age, the presence of hypertension, the presence of more severe coronary disease, and more extensive myocardial damage.

Immediate 201Tl reinjection

Thallium-201 (201Tl) stress-redistribution/reinjection imaging provides a reliable diagnostic approach in patients evaluated for myocardial ischaemia. Immediate reinjection of 201Tl after completing the stress images followed by imaging 1 h later shortens the investigation time to 2.5 h and may provide a novel approach. In this study, we validated the immediate reinjection approach in the assessment of myocardial perfusion and viability using contrast angiographic findings as the reference standard. We studied 114 patients with documented cardiac catheterization data using quantitative planar 201Tl stress/immediate reinjection imaging. The 201Tl findings were compared with contrast angiographic data, coronary arteriographic findings and electrocardiographic data. Myocardial regions were considered to be viable if they (1) showed normal or hypokinetic wall motion, (2) were supplied by patent coronary arteries or by occluded arteries with adequate collateral circulation, or (3) were not related to electrocardiographic infarct site. Myocardial regions were considered to be non-viable if they (1) showed akinetic or dyskinetic wall motion, (2) were supplied by occluded vessels with inadequate collateral circulation, or (3) were related to electrocardiographic infarct site. Of 280 regions with normal or hypokinetic wall motion, 47 (17%) regions showed persistent 201Tl defects compared with 21 of 26 (81%) regions with akinetic/dyskinetic wall motion (P < 0.0001). Of 318 regions supplied by patent vessels, 65 (20%) regions showed persistent 201Tl defects compared with 14 of 22 (64%) regions subtended by occluded vessels (P < 0.0001). When the 201Tl findings were compared with electrocardiographic infarct site, 37 of 259 (14%) remote regions showed persistent defects compared with 42 of 83 (51%) infarct-related regions (P < 0.0001). We conclude that persistent defects on 201Tl immediate reinjection images are significantly more often associated with severe left ventricular wall motion abnormalities, coronary artery occlusion and infarct-related regions. In particular, agreement between the wall motion approach and scintigraphic findings was excellent, with 21 of 26 akinetic or dyskinetic segments showing persistent defects and 233 of 280 normal or hypokinetic segments measured as viable by the reinjection technique, resulting in a sensitivity of 81%, a specificity of 83% and an overall accuracy of 83%. These findings show the potential of immediate 201Tl reinjection imaging for assessing myocardial perfusion and viability.

Left Atrial Myxomas: Using Gross Anatomic Tumor Types to Determine Clinical Features and Coronary Angiographic Findings

To our knowledge, there have been no reports focusing on differences of clinical characteristics according to two gross anatomic types of cardiac myxomas. This study evaluated the differences of clinical features, coronary arteriographic findings, and histopathologic findings. Twenty-six patients who underwent surgical excisions for left atrial myxomas were analyzed. According to the gross anatomic types, they were divided into two groups: group 1 having solid and ovoid myxomas (n = 14), and group 2 having soft and papillary myxomas (n = 12). Differences of presenting symptoms, prevalence of brain infarction, coronary angiographic findings, and histopathologic findings were analyzed. An incidence of dyspnea was significantly higher in group 1 (78.6% vs 33.3%, p < 0.05) than in group 2. That of neurologic symptoms was higher in group 2 (75% vs 14.3%, p < 0.01) than in group 1. A prevalence of brain infarction was higher in group 2 (75% vs 2.5%, p < 0.05) than in group 1. On coronary angiography, an identification rate of clusters of tortuous vessels was higher in group 1 (81.8% vs 0%, p < 0.01) than in group 2. In histologic findings, most of group 1 tumors displayed many hemorrhages, small vessels, and fibrosis in the stroma, but group 2 had few such structures. Coronary angiographic findings of tumor-feeding arteries without clusters of tortuous tumor vessels predict a myxoma that is papillary in type. At that time, close attention should be given for the possible existence of silent brain infarction.

Lack of a Thrombotic Tendency in Patients with Acute Myocardial Infarction and Angiographically Normal Coronary Arteries

The hematological profile of 12 patients with acute myocardial infarction and normal coronary arteriographic findings was compared to that of 8 patients with acute myocardial infarction associated with obstructive coronary artery disease, and of 12 patients with no evidence of myocardial infarction and normal coronary arteriographic and left ventriculographic findings who served as control. There were no significant differences in the hematological profile among the 3 groups, suggesting lack of a thrombotic tendency in patients with acute myocardial infarction and normal coronary arteriographic findings.

Injury of Renal Artery Branches by Blunt Trauma: Arteriographic Findings and Transarterial Embolotherapy

Injury of Renal Artery Branches by Blunt Trauma: Arteriographic Findings and Transarterial Embolotherapy

Value of Angioscopy for Intraoperative Assessment of Carotid Endarterectomy

From March 1992 to November 1993 we used angioscopy and arteriography for intraoperative assessment of 103 carotid endarterectomies in 96 patients. The indication for surgery was asymptomatic stenosis in 55 cases and neurologic and/or ocular symptoms in 48. Intraoperative angioscopy and arteriography were performed to allow comparison of findings. Intraoperative angioscopic images were normal in 67 cases and abnormal in 36. The defect was an intimal flap in 26 cases, detachment of the distal plaque in seven cases, and an intimal wedge in five cases. In two cases both detachment and a wedge were observed. The defect was not considered severe enough to warrant revision in 31 cases and was corrected in five cases by either vein bypass (n = 1) or revision of the endarterectomy (n = 4). In the latter four cases repeat angioscopy showed normal findings. Arteriographic and angioscopic findings were compared in 102 cases. In the 71 cases in which angioscopic findings were normal, arteriography revealed a major abnormality in three cases: kinking in one and stenosis > 40% in two. Kinking was treated by attachment of the common carotid artery and stenosis by venous bypass. In the 31 cases in which angioscopy revealed defects not considered to warrant revision, arteriography revealed stenosis > 40% in three cases treated by either prosthetic bypass (n = 2) or revision of the endarterectomy (n = 1). The false negative rate for angioscopy was 5.9% and concordance between the two methods was 94.1%. The combined mortality-morbidity rate was 1.9% (one stroke and one death). Postoperative evaluation of anatomic findings by arteriography or Doppler ultrasonography revealed asymptomatic internal carotid occlusion in one and internal carotid stenosis < 30% in four cases. Angioscopy is a simple, low-cost method in intraoperative control that can be used either as an adjunct to arteriography or as an alternative if arteriography cannot be performed.

Clinical and arteriographic characterization of patients with unstable angina without critical coronary arterial narrowing (from the TIMI-IIIA trial)

Previous studies have reported that some patients presenting with unstable angina are found at coronary angiography to have no critical coronary stenosis. This study evaluated the clinical presentation and arteriographic findings in patients enrolled in the Thrombolysis in Myocardial Ischemia (TIMI-IIIA) trial, which assessed the effect of tissue-type plasminogen activator added to conventional therapy on the coronary arteriographic findings in patients presenting with ischemic pain at rest. Three hundred ninety-one patients were enrolled in the TIMI-IIIA trial and underwent coronary arteriography within 12 hours of enrollment. Fifty-three patients (14%) had no luminal diameter stenosis of a major coronary artery of ≥60% on the baseline arteriogram. Compared with patients with unstable angina with an identifiable culprit lesion, patients without critical coronary obstruction were more likely to be women and non-white and less likely to have ST-segment deviation on the presenting electrocardiogram. Arteriography in such patients revealed no visually detectable coronary stenosis in half of the group; the remaining patients had noncritical coronary narrowing (i.e., <60% luminal diameter stenosis) without morphologic features (ulceration or thrombus) suggestive of unstable or active coronary plaque. Nearly one third of the patients without critical coronary stenosis had impaired angiographic filling, suggesting a possible pathophysiologic role for coronary microvascular dysfunction. These patients with unstable angina and no critical coronary obstruction had an excellent short-term prognosis; 2% died or had myocardial infarction compared with 18% of patients with critical obstruction.

Arterial abnormalities following orthotopic liver transplantation: arteriographic findings and correlation with Doppler sonographic findings.

We studied the findings on conventional arteriography in patients who had suspected graft ischemia after orthotopic liver transplantation to determine the value of a single Doppler signal in predicting these lesions. We retrospectively reviewed selective visceral arteriograms with abnormal findings from 20 adults who had suspected graft ischemia after orthotopic liver transplantation and a single Doppler signal from the hepatic artery at the porta hepatis on sonograms obtained before arteriography. Arteriographic abnormalities were categorized according to morphology and location as follows: stenosis of recipient's hepatic artery, occlusion or stenosis of the transplanted extrahepatic artery, and occlusion or stenosis of the transplanted intrahepatic artery. Twenty-three arteriographic abnormalities were detected: four recipient celiac axis stenoses, seven extrahepatic occlusions, nine extrahepatic stenoses, and two occlusions and one stenosis of the transplanted intrahepatic artery. Six of the extrahepatic occlusions, two of the extrahepatic stenoses, and none of the recipient artery stenoses or the intrahepatic occlusions or stenoses were correctly diagnosed on the basis of Doppler findings. One patient with both an extrahepatic stenosis and an extrahepatic occlusion was thought to have an intrahepatic occlusion, and two patients with mild (< 50%) extrahepatic stenoses and one with an intrahepatic occlusion were thought to have an extrahepatic occlusion. A wide spectrum of abnormalities in the recipient's celiac axis or the transplanted arteries that may be associated with graft ischemia after orthotopic liver transplantation are often not detected or findings are misinterpreted on routine Doppler examination. In patients with suspected graft ischemia, visceral arteriography should be performed promptly to confirm the diagnosis and to allow early intervention.

Serial arteriographic findings in a patient with development of an unusually large coronary aneurysm after angioplasty

1. Wrisley D, Giambartolomei A, Lee I, Browntee W. Left atria1 ball thrombus: Review of clinical and echocardiographic manifestations with suggestions for management. AM HEART J 1991;121:1764-90. 2. Wrisley D, Giambartolomei A, Levy I, Brownlee W, Lee I, Erickson J. Left atria1 ball thrombus: apparent detachment following initiation of anticoagulant therapy. AM HEART J 1988;116:1351-2. 3. Tsuda Y, Satoh K, Matsuo H. Formation of left atria1 ball thrombus during anticoagulation in a case of cerebral embolism. Stroke 1990;21:1375-6. 4. Habibzadeh M. Left atria1 thrombus despite anticoagulant therapy in a patient with mitral valve prosthesis. South Med J 1980:73:824-5.

Stationary Arterial Wave Phenomena

The case of a 38-year-old woman who was struck by an automobile is presented. The workup for lower extremity injuries revealed stationary arterial waves. Recognition of this arteriographic finding may avoid unnecessary confusion or exploration.

Coronary arteriographic findings in black patients and risk markers for coronary artery disease

Coronary arteriographic results are reported in 1535 black patients: 751 men (mean age 57 ± 11) and 784 women (mean age 59 ± 11). Among the black men 19%, 15%, 21%, and 4% had single-, double-, and triple-vessel and left main disease, respectively. Among the black women there were 12%, 10%, 15%, and 3% with similar involvement. Logistic regression models showed that most of the recognized risk factors were positively correlated with significant (at least one artery with ≥50% stenosis) coronary disease, but a history of hypertension was not a significant independent predictor in either sex. ECG evidence of previous infarction increased the odds of detecting significant coronary disease by the greatest amount when controlling for other significant risk markers in women. In men both previous infarction and atypical pain (negative) were equally important. This study confirms but does not explain previous reports that have revealed less than expected angiographic evidence of significant coronary artery disease in black compared with white persons.

Determination of regional myocardial blood flow with 13N-ammonia positron emission tomography during low-grade exercise for evaluating coronary artery stenosis.

We measured regional myocardial blood flow (RMBF) by positron emission tomography (PET) with 13N-ammonia at rest and during low-grade exercise using a bicycle ergometer fixed at 25 watts for 6.5 min. The ischemic area with severe coronary artery stenosis was evaluated in terms of quantitative RMBF. The study was performed in 46 subjects consisting of 19 patients with old myocardial infarction, 20 with effort angina pectoris, and 7 normal individuals. RMBF was calculated using the radioactivity in myocardial tissue measured by PET and the radioactivity in arterial blood. The PET data were compared with coronary arteriographic findings and ECG findings. When the analysis was restricted to the anterior wall of the myocardium, it was found that exercise caused RMBF to increase by 44.9% (n = 28) in normal area, to increase by 23.3% (n = 37) in severely stenotic area (stenosis > or = 90%), and to decrease by 17.4% (n = 20) in infarcted area. When we considered only the infarcted area of the entire heart, exercise caused RMBF to decrease by 26.6% (n = 30) in the area of angiographically positive collaterals, and to increase by 0.8% (n = 31) in the area of negative collaterals. Thus, we were able to quantitate the degree of ischemia in myocardium that was associated with severe coronary artery stenosis. By application of low-grade exercise, RMBF in normal myocardium increased, while RMBF in myocardium perfused by collaterals decreased.

Three-dimensional spiral computed tomographic angiography: An alternative imaging modality for the abdominal aorta and its branches

Purpose: We sought to apply a new technique of computed tomographic angiography (CTA) to the preoperative and postoperative assessment of the abdominal aorta and its branches.Methods: After a peripheral intravenous contrast injection, the patient is continuously advanced through a spiral CT scanner, while maintaining a 30-second breath-hold. Thirty-five patients with abdominal aortic, renal, and visceral arterial disease have undergone CTA.Results: Diagnostic three-dimensional images were obtained in patients with aortic aneurysms (n = 9), aortic dissections (n = 4), and mesenteric artery stenoses (n = 4). The technique has also been used to assess vessels after operative reconstruction or endovascular intervention in 18 patients. These preliminary studies have correlated well with conventional arteriographic findings. In aneurysmal disease both the lumen and mural thrombus and associated renal artery stenoses are visualized. The true and false channels of aortic dissections and the perfusion source of the visceral vessels are clearly shown; patency of visceral and renal reconstruction or stent placement are confirmed. CTA is relatively noninvasive and can be completed in less time than conventional angiography with less radiation exposure.Conclusions: This initial experience suggests that CTA may be a valuable alternative to conventional arteriography in the evaluation of the aorta and its branches.