Computed Tomography Angiography Results Research Articles

Effect of pelvic arterial stenosis on erectile function: determining the severity threshold for erectile dysfunction.

Pelvic arterial (PLA) stenosis is associated with arterial insufficiency of the penis and erectile dysfunction (ED), but the effect of different severities of PLA stenosis on ED remains unclear. To investigate how different severities of PLA stenosis affect erectile function. We included patients who visited our clinic for ED and underwent computed tomography angiography (CTA) and dynamic duplex sonography (DUS). The erectile hardness score (EHS), simplified International Index of Erectile Function (IIEF-5), DUS and CTA results, and flow index (FI) calculated from the peak systolic velocity (PSV) and PLA stenosis percentages were analyzed. EHS < 3 was defined as significant ED. PLA stenosis was analyzed by the mean PLA (average of the right and left PLA) and unilateral or bilateral stenoses. According to severity, stenosis was classified as mild, moderate, or severe. Subjective and objective parameters, including the IIEF-5 score, EHS, PSV, and FI, in relation to different severities of PLA stenosis. The study included 182 patients. Vascular parameters such as the mean PSV, PLA stenosis, and FI correlated with EHS and IIEF-5 scores. Receiver operating characteristic analyses for predicting EHS ≥ 3 showed that all vascular parameters had acceptable discriminatory ability. During the analysis performed using the mean PSA stenosis, EHS decreased in patients with mild and severe mean PLA stenosis, although a PSV drop was noted only in severe cases. The proportion achieving EHS 3 significantly dropped in patients with at least mild mean PLA stenosis. Using unilateral or bilateral PLA stenosis, the EHS significantly dropped in patients with severe unilateral and bilateral PLA stenosis, with PSV decreasing on the affected side in severe unilateral stenosis. However, the mean PSV did not drop despite different unilateral stenosis severities. The proportion achieving EHS 3 significantly dropped among patients with at least moderate unilateral PLA stenosis and bilateral PLA stenosis but not in mild unilateral cases. The severity of PLA stenosis is correlated with the risk of ED. The strength of this study lies in its analysis of the effect of PLA stenosis on erectile function from various perspectives, including unilateral, bilateral, and mean stenosis. However, the absence of validation regarding the outcomes of endovascular therapy is a limitation. Mild mean PLA stenosis and moderate unilateral PLA stenosis are associated with increased risks of ED; however, mild unilateral PLA stenosis does not affect erectile function.

Correlation between CT Renal Angiography of Live Kidney Donors and Intraoperative Findings: A Cross-Sectional Study

Introduction: A comprehensive understanding of the renal vascular anatomy variations is paramount to a successful kidney transplant. This reduces vascular injury risks and minimizes ischemia duration, optimizing surgical outcomes. The current study aims to assess the accuracy of renal computed tomography angiography (CTA) findings of live renal donors by comparing them with intraoperative findings. Methods: This prospective cross-sectional study was conducted between October 2018 and February 2020. It included all healthy donors with two kidneys of normal size, shape, and position who were deemed suitable for nephrectomy. The CTA examinations were performed with the same protocol, which combined the vascular-excretory phase. Anatomical findings were recorded by a specialized radiologist. The CTA results were compared with intraoperative findings, which were documented by the transplantation team. Results: The study included 220 patients. The preoperative CTA was highly sensitive and accurate, reaching 99.5% and 98.6%, respectively, for single vessels and 100% sensitivity and accuracy for triple vessels, pelvicalyceal system, and ureter duplication. The sensitivity of CTA for double vessels (vein and artery) was 90% and 92.6%, respectively, while accuracy was 98.6% for both. Conclusion: CTA can be used to assess renal arteries and veins for potential renal donors with high accuracy. Although the CTA’s minor, statistically nonsignificant discordance with the surgical findings regarding double arteries and veins, no artery or vein was missed on the CTA. Therefore, the sensitivity of CTA can reach 100%.

High-Risk Plaque Features in the Non-stenosing Carotid Artery, How Frequently is This Reported? A Retrospective Study.

High-risk features of non-stenosing (ie, <50%) carotid plaques are emerging as a possible source of embolism in patients with embolic stroke of undetermined source (ESUS). However, in the absence of hemodynamically significant stenosis, neuroradiology reports rarely describe these morphological features. Our aim was to determine how often high-risk features of non-stenosing plaques are included in diagnostic imaging reports. In this retrospective study, we evaluated computed tomography angiography (CTA) reports associated with the CTA imaging results for a previously published cohort study. Plaque features reporting frequencies were calculated and defined as the number of times specific plaque features were included in the CTA reports (Thickness, ulceration, length, soft component and calcification) divided by the number of occurrences of high-risk plaque features (Thickness >0.3cm; ulceration; length >1.0cm), soft component, or calcification identified in the CTA results. We used Fisher exact test to compare the reporting frequencies of the 5 plaque features. We analyzed 152 CTA reports. The frequency of reporting plaque thickness (0/40; 0%), ulceration (3/37; 8.1%), and length (7/29; 24.1%) was significantly lower than the reporting of plaque calcification (122/122; 100%) and presence of soft component (31/34; 72.1%) when these features were present in CTA imaging results (all P < 0.001). When carotid plaques are not causing hemodynamically significant stenosis, neuroradiology reports frequency mention plaque density but often exclude other characteristics. Neuroradiologists and neurologists should collaborate to create algorithms, scoring systems and prediction models to accurately determine which plaque features are highly associated with embolism.

Establishment and Validation of an Animal Model of Abdominal Aortic Aneurysm in Beagles Through Vascular Patch Angioplasty and Elastase Infusion

To evaluate the effect of an abdominal aortic aneurysm (AAA) animal model established in beagles by way of vascular patch angioplasty combined with elastase infusion. A total of 60 beagle dogs were included in this study. Among them, 10 beagles were assigned to a control group to obtain normal abdominal aortic wall tissue, while the other 50 underwent vascular patch angioplasty combined with elastase infusion in order to establish the AAA disease model. In order to evaluate the outcome of modeling, abdominal vascular ultrasonography was performed 14 days after the modeling surgery was performed and ultrasound and computed tomographic angiography (CTA) were performed 28 days after the modeling surgery. The criterion for evaluating modeling success is that the maximum diameter of the abdominal aortic aneurysm is 50% greater than the diameter of the normal abdominal aorta below the renal artery. A total of 20 beagles of the modelling group and 5 control beagles were sacrificed 35 days after the modeling surgery and infrarenal abdominal aortic wall tissues were harvested. Then, hematoxylin and eosin (H&E) staining, Masson's trichrome staining, and elastic van Gieson (EVG) staining were conducted to observe the pathology features of abdominal aortic wall tissues. A total of 50 beagles underwent the AAA modeling procedures, with the average operative and anesthesia time being (119.4±18.9) and (137.4±15.8) minutes, respectively, the average blood loss volume being (43.6±7.7) mL, the average abdominal aorta block time being (39.7±5.3) minutes during the modeling surgery, and the average abdominal aorta diameter measured during the surgery being (6.5±0.4) mm. Intraoperative mortality was 0%. Mortality within 30 days after the surgery was 2% (1 out of the 50 beagles). Postoperative ultrasound and CTA results revealed that the success rate of AAA modeling was 100%. Pathology examination suggested that the animal model rather successfully simulated the pathophysiologic changes associated with human AAA in regard to the morphological and pathological changes. Vascular patch angioplasty combined with elastase infusion can be used to successfully establish AAA model in beagles. The AAA modeling method described in our report demonstrates stability and reliability in aneurysm formation effect and the surgical procedures are easy to replicate. The method integrates the advantages of previous animal modeling methods and can be used to study the pathogenesis of AAA.

Peak systolic velocity ratio for evaluation of internal carotid artery stenosis correlated with plaque morphology: substudy results of the ANTIQUE study.

Accurate assessment of carotid stenosis severity is important for proper patient management. The present study aimed to compare the evaluation of carotid stenosis severity using four duplex sonography (DUS) measurements, including peak systolic velocity (PSV), PSV ratio in stenosis and distal to stenosis (PSVICA/ICA ratio), end-diastolic velocity (EDV), and B-mode, with computed tomography angiography (CTA), and to evaluate the impact of plaque morphology on correlation between DUS and CTA. Consecutive patients with carotid stenosis of ≥40% examined using DUS and CTA were included. Plaque morphology was also determined using magnetic resonance imaging. Spearman's correlation and Kendall's rank correlation were used to evaluate the results. A total of 143 cases of internal carotid artery stenosis of ≥40% based on DUS were analyzed. The PSVICA/ICA ratio showed the highest correlation [Spearman's correlation r = 0.576) with CTA, followed by PSV (r = 0.526), B-mode measurement (r = 0.482), and EDV (r = 0.441; p < 0.001 in all cases]. The worst correlation was found for PSV when the plaque was calcified (r = 0.238), whereas EDV showed a higher correlation (r = 0.523). Correlations of B-mode measurement were superior for plaques with smooth surface (r = 0.677), while the PSVICA/ICA ratio showed the highest correlation in stenoses with irregular (r = 0.373) or ulcerated (r = 0.382) surfaces, as well as lipid (r = 0.406), fibrous (r = 0.461), and mixed (r = 0.403; p < 0.01 in all cases) plaques. Nevertheless, differences between the mentioned correlations were not statistically significant (p > 0.05 in all cases). PSV, PSVICA/ICA ratio, EDV, and B-mode measurements showed comparable correlations with CTA in evaluation of carotid artery stenosis based on their correlation with CTA results. Heavy calcifications and plaque surface irregularity or ulceration negatively influenced the measurement accuracy.

Long-term outcomes following exclusive use of endovascular aortic repair for ruptured infrarenal abdominal aortic aneurysms.

Long-term outcomes following exclusive use of endovascular aortic repair for ruptured infrarenal abdominal aortic aneurysms.

Radiological Assessment of Extracranial Vertebral Artery Variations: A Computed Tomography Angiography Study

We evaluated the incidence of intraforaminal and extraforaminal variations of the vertebral artery (VA) in the Omani population using computed tomography angiography (CTA). CTA results of 579 consecutive Omani patients (1158 VAs) were reviewed retrospectively for the analysis of unusual entrance transverse foramen (UE-V2), midline migration (MM), persistent first intersegmental artery (PFIA), and paracondylar process (PP) variations of VA. The anomalous origin and VA dominance were also determined. The sex and side differences in the incidence of these variations were analyzed using the Chi-square test. The incidence of UE-V2 was observed in 10.44% (121 out of 1158) of cases. The incidence of UE-V2 at different vertebral levels was observed in the sequence of C5 (71%) &gt; C4 (20.7%) &gt; C7 (7.43%) &gt; C3 (0.8%). The incidence of MM variation was 1.29%. PFIA and PP variations were found in 0.17% and 0.60% of cases, respectively. Left-dominant VA was identified in 44.7% (259 out of 579) of subjects. The incidence of VA variations was not significantly associated with either sex or side. Anomalous VA origin from arch aorta (3.5%) and right common carotid artery (CCA) (0.08%) was identified. The incidence of UE-V2 in Omani subjects is comparatively higher than that reported in other Asian populations. A rare case of VA originating from the right CCA was also identified.

Evaluation of coronary disease among patients undergoing transcatheter aortic valve implantation: propensity score matching analysis.

Chronic coronary syndrome (CCS) is common among elderly patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI). Current guidelines recommend performance of percutaneous coronary intervention (PCI) of any > 70% proximal coronary lesions prior to TAVI. To evaluate the outcomes of two diagnostic approaches for CCS clearance pre-TAVI and to determine the reduction in the need of invasive angiography (IA). We investigated 2219 patients undergoing TAVI for severe aortic stenosis at two large centers with different pre-procedural strategies for CCS assessment: pre-TAVI computed tomography angiography (CTA) with selective invasive angiography according to CTA results or mandatory IA. We preformed propensity score matching analysis using a 1:1 ratio. The final study cohort included 870 matched patients. Peri-procedural complications were documented according to the VARC-2 criteria. Mortality rates were prospectively documented. Mean age of the study population was 82 ± 7, of whom 55% were female. Patients in the IA group had significantly higher rates of pre-TAVI PCI compared to the CTA group (39% vs. 22%, p < 0.001). Following TAVI, peri-procedural myocardial infarction (MI) rates were similar between the two groups (0.3% vs. 0.7%, p value = 0.41), but spontaneous MI were significantly lower among the IA group (0% vs. 1.3%, p value = 0.03). Kaplan-Meier's survival analysis found that the cumulative probability of 1-year morality was similar between the two groups (p value log rank = 0.65). Cox regression analysis did not find association between CCS clearance strategy and outcome. In elderly patients, CTA-driven approach for CCS evaluation pre-TAVI is a valid strategy with similar outcome as compared to invasive approach. CTA strategy significantly reduces invasive procedures rates without compromising patient's outcome.

Volumetric analysis on computed tomography Angiography in the management of thoracic aortic dissection in case of seven years follow-up period

Purpose. To establish the methods for estimating the volume of the true and false aortic canals applying computed tomography angiography (CTA) to a clinical case with hybrid stent-graft thoracic aorta with distal stent-graftinduced new entry associated (d-SINE) in the long-term follow-up period in comparison with a widely used technique of measuring diameters of the aorta on different levels.Materials and methods. Sequential analysis of CTA in a 7-year follow-up was performed. Aorta was divided into 3 segments, in each segment total aortic volumes (AV), volume of the true canal (TC), and volume of functional lumen of the false canal (FLFC) were calculated. The following were mathematically calculated: volume of the false canal (FC) via difference in volume between AV and TC, volume of the thrombosed lumen of FC as the difference between FC and FLFC, the coefficient of FC thrombosis, the degree of stent-graft opening. Mathematical assessment of excess volume of the graft was performed.Results. Modelling of aortic cavity, evaluation of changes in the volumes of TC and FC during a long-term follow-up, analysis of the factors inducing the development of the d-SINE syndrome were performed. When comparing the volume of the graft and the volume of the implantation zone, an excess of 234% was found, while the opening of the graft was 80%. When using the reference method based on the diameter of the true lumen of the aorta, the excess was 22% during one-year follow-up period showing no changes subsequently.Conclusion. Potentially, the method of measuring volumes based on CTA results can be used to complement the generally accepted method based on measuring diameters, since it does not require additional financial resources and has the potential to estimate effectiveness of treatment and identify complications predictors in the postoperative period to determine indications for reoperation.

Fractal Analysis of Dynamic Stress CT-Perfusion Imaging for Detection of Hemodynamically Relevant Coronary Artery Disease

BackgroundCombined computed tomography–derived myocardial blood flow (CTP-MBF) and computed tomography angiography (CTA) has shown good diagnostic performance for detection of coronary artery disease (CAD). However, fractal analysis might provide additional insight into ischemia pathophysiology by characterizing multiscale perfusion patterns and, therefore, may be useful in diagnosing hemodynamically significant CAD. ObjectivesThe purpose of this study was to investigate, in a multicenter setting, whether fractal analysis of perfusion improves detection of hemodynamically relevant CAD over myocardial blood flow quantification (CTP-MBF) using dynamic, 4-dimensional, dynamic stress myocardial computed tomography perfusion (CTP) imaging. MethodsIn total, 7 centers participating in the prospective AMPLIFiED (Assessment of Myocardial Perfusion Linked to Infarction and Fibrosis Explored with Dual-source CT) study acquired CTP and CTA data in patients with suspected or known CAD. Hemodynamically relevant CAD was defined as ≥90% stenosis on invasive coronary angiography or fractional flow reserve <0.80. Both fractal analysis and CTP-MBF quantification were performed on CTP images and were combined with CTA results. ResultsThis study population included 127 participants, among them 61 patients, or 79 vessels, with CAD as per invasive reference standard. Compared with the combination of CTP-MBF and CTA, combined fractal analysis and CTA improved sensitivity on the per-patient level from 84% (95% CI: 72%-92%) to 95% (95% CI: 86%-99%; P = 0.01) and specificity from 70% (95% CI: 57%-82%) to 89% (95% CI: 78%-96%; P = 0.02). The area under the receiver-operating characteristic curve improved from 0.83 (95% CI: 0.75-0.90) to 0.92 (95% CI: 0.86-0.98; P = 0.01). ConclusionsFractal analysis constitutes a quantitative and pathophysiologically meaningful approach to myocardial perfusion analysis using dynamic stress CTP, which improved diagnostic performance over CTP-MBF when combined with anatomical information from CTA.

Comparison of Invasive Coronary Angiography Versus Computed Tomography Angiography to Assess Mehran Classification of In-Stent Restenosis in Bifurcation Percutaneous Coronary Intervention

The Mehran classification is used to determine the presence of in-stent restenosis (ISR) and characterization of its subtypes in invasive coronary angiography (ICA). The utility of computed tomography angiography (CTA) for the assessment of Mehran classification is unknown. We aimed to compare the agreement and reproducibility of Mehran classification between ICA and CTA and evaluate the sensitivity and specificity of both imaging methods. Consecutive patients who had ISR on ICA preceded with CTA before intervention were enrolled in our study. Modified Mehran's classification was employed by CTA and ICA to classify ISR into 4 subtypes: focal (type I [A, B, C]), intra-stent (type II [A, B, C]), proliferative (type III [A, B, C]), and total occlusion (type IV). Agreement between ISR classification and main vessel lesion length, reference vessel diameter, and bifurcation angles were compared. A total of 405 patients with 431 bifurcation percutaneous coronary interventions with ISR were included in this investigation. The total agreement between CTA and ICA for assessment of Mehran class was poor (kappa=0.168). Proliferative ISR (25% vs 10%, p=0.012) and total occlusions (24% vs 5%, p <0.001) were reclassified more often between ICA and CTA, respectively. CTA assessment of lesion length was significantly longer than that of ICA measurements in all subtypes of ISR (32.15 ± 5.23 vs 27.41 ± 3.63, p = 0.004). Receiver operating characteristic curve expressed CTA to be more sensitive and specific than ICA in diagnosing ISR. In conclusion, Mehran classification was significantly affected by imaging modality, and CTA results were more reproducible than ICA. Therefore, CTA evaluation of ISR may facilitate treatment options and generate a sound plan before the procedure.

Value of contrast-enhanced ultrasound for diagnosis and follow-up of renal artery stenosis in patients with chronic kidney disease.

To evaluate whether contrast-enhanced ultrasound (CEUS) is an accurate, non-nephrotoxic diagnostic method and follow-up tool for use in patients with chronic kidney disease (CKD) and renal artery stenosis (RAS). In this prospective and monocentric study, we compared the sensitivity and specificity of CEUS for the diagnosis of RAS in CKD patients, using digital subtraction angiography (DSA) or computed tomographic angiography (CTA) as the gold standard methods. Further, the value of CEUS for distinguishing restenosis from other diseases was assessed. The ultrasound physicians conducted the examinations and served as the CEUS report readers who were blinded to the DSA or CTA results. Patients with RAS (n = 60) were enrolled. Average patient age was 64.4 ± 18.0years and median estimated glomerular filtration rate was 66.1mL/min/1.73 m2. CEUS was used to image 94 stenotic renal arteries and DSA- or CTA-verified stenosis was present in 96 renal arteries. The kappa value for CEUS was 0.776 (P < 0.001), with an accuracy of 92.5%, a sensitivity of 94.7%, and a specificity of 84.0%. The accuracy of CEUS was the same for the diagnosis of the CKD3b-5 group as for the CKD1-3a group (100% vs. 87.5%, P = 0.148). There was no difference in CEUS accuracy for the diagnosis of Takayasu RAS compared with atherosclerotic RAS (95.8% vs. 91.7%, P = 0.795). Twenty-nine CEUS examinations were performed to follow in-stent restenosis or progression of RAS, with a median follow-up time of 5.0months (range 1.0-20.0). Two cases of in-stent restenosis in patients suffering from deteriorating kidney function and recurrent hypertension were examined by CEUS. CEUS examination is a credible alternative for diagnosing moderate and severe RAS in patients with CKD, and is a reliable tool for follow-up surveillance after renal artery revascularization treatment. It shouldn't be thought as a color-coded duplex ultrasonography rescue in these patients.

Reconsidering the Relationship Between Hand Preference and Cerebral Vascular Dominance: A Computed Tomography (CT) Angiography Study.

To date, it has been suggested that there may be many genetic, environmental, and vascular factors that affect hand preference. In previous studies evaluating the relationship between cerebral dominance and hand preference, carotid and vertebral artery (VA) Doppler ultrasonography (USG) was generally preferred; and these studies only measured VA diameters. Unlike other studies, we aimed to reevaluate the relationship between hand preference and cerebral vascular dominance by measuring VA and internal carotid artery (ICA) diameters. In addition, we used carotid and VA computed tomography (CT) angiography instead of Doppler USG. A total of 345 participants were included in the study. The results of carotid and VA CT angiography taken during hospitalization were retrospectively evaluated by two radiologists, and the Edinburgh Hand Preference Questionnaire was applied to these patients. In right-handed patients, the diameter of the left VA was significantly larger than the diameter of the right VA (p = 0.005). In left-handed patients, the diameter of the left ICA was larger than the diameter of the right ICA, but the difference was not statistically significant (p = 0.055). There was no significant difference between the diameter of the right and left ICA in right-handed patients (p = 0.771). In our study, we found a correlation between the dominant hemisphere VA diameter and hand preference. Using CT angiography, we were able to eliminate many challenges of ultrasonography that make radiological evaluation difficult, such as differences of opinion between radiologists, and technical and anatomical reasons.

Value of multislice computed tomography-coronary angiography in predicting coronary artery diseases in type-2 diabetic patients in the chest pain unit

Background and aim Diabetes mellitus is a metabolic disorder affecting a wide range of the population all over the world. Microvascular and macrovascular complications are very common in diabetic patients with high incidence of affection of the coronary arteries. Rapid and efficient management in cases (especially diabetics) complaining of chest pain at the emergency department is a matter of great importance to decrease the incidence of subsequent complications. Our aim was to predict coronary artery diseases in type-2 diabetic patients with typical chest pain with normal initial cardiac investigations at the emergency room by using computed tomography (CT) coronary angiography. Patients and methods A total number of 100 patients were included in this study and classified into two groups: 80 patients with diabetes mellitus (group A) and 20 nondiabetic patients (group B) presented with chest pain. Complete history was taken from the cases with performing of complete physical examination, and routine laboratory and radiological investigations. Additionally, echocardiography and multislice CT-coronary angiography (coronary computed tomography angiography) were done for all cases. Also, calcium score was calculated. Results CT angiography revealed affection in 19 (23.8%) cases of the cases in group A with no affected cases in group B with a statistically significant difference between the two groups. There was a high statistically significant agreement between the findings of the CT angiography and coronary angiography results (P&lt;0.001). CT angiography had sensitivity of 70.37%, specificity of 100%, positive predictive value 100%, negative predictive value 86.89%, and accuracy of 90%. Conclusion An early coronary computed tomography angiography strategy has revealed high sensitivity in prediction of coronary artery disease affection as compared with ordinary coronary angiography in cases presented with chest pain to emergency department.

Pulmonary thromboembolism with transthoracic ultrasound and computed tomography angiography.

The detection of pulmonary embolism in emergency department requires an urgent therapeutic and diagnostic attention. This study was performed to determine the accuracy and efficacy of ultrasound in the diagnosis of pulmonary embolism. In this study, 110 patients who referred to the emergency department with traumatic embolism symptoms were enrolled. All the patients underwent computed tomography (CT) angiography. Patients were divided into positive and negative outcomes according to the results of transthoracic ultrasonography and CT angiography. In this study, 110 patients were enrolled, of whom 52 (47.3%) were male and 58 (52.7%) were female. Among the patients, 100 (90.9%) patients presented with dyspnea, whereas the frequency of pleural pain was 27% (24.5%). Sensitivity, specificity, positive predictive value, and negative predictive value for ultrasound were 45.67%, 77.41%, 88.09%, and 35.29%, respectively. The positive outcomes from CT scan were significantly associated with gender, p = 0.005. The gender and transthoracic ultrasonography outcomes were also significantly correlated, p = 0.019, and the outcomes of ultrasound were significantly different from those of CT scan, p = 0.008. Transthoracic ultrasonography may be used to diagnose pulmonary embolism as a technique in the emergency department, especially in patients who are unable to move due to the severity of the disease. However, further comparative studies are required in this aspect.

CT ANGIOGRAPHY FOR DETECTING THE CAUSE OF INTRACRANIAL HEMORRHAGE IN THE EMERGENCY DEPARTMENT

Background Intracranial hemorrhage is the most serious manifestation of a ruptured cerebral aneurysm, and subarachnoid hemorrhage (SAH) is the most common clinical and anatomical form. The treatment strategy for SAH varies from conservative to emergency surgical treatment and depends on the source of the hemorrhage. Currently, the search for sources is carried out using various methods of diagnostic radiology. Objective To compare the images of intracranial arteries obtained by computed tomography (CT) angiography with the data of cerebral angiography in the acute period of hemorrhage in the subarachnoid space. Material and Methods We retrospectively analyzed the medical records of 242 patients with acute SAHs from September 2017 to September 2019, examined in the emergency room of the Research Institute – Ochapovsky Regional Hospital no. 1. Results According to CT angiography, the initially occult vascular lesion was verified in 212 patients (87%), of which in 84.0% of cases (205 patients) the cause of SAH was ruptured cerebral aneurysms. In 3 patients, ruptures of arteriovenous malformations were detected (1.2%). In 4 patients, the “cerebral aneurysms” diagnosis was excluded due to the establishment of a hypertensive nature of intracranial hemorrhage (1.7%). In 30 patients, CT angiography revealed no vascular pathology. According to the results of CT angiography only, 225 patients (93%) were microsurgically operated on, and 12 patients (5%) were operated on using intravascular access. Among 30 patients whose vascular pathology was not detected by CT angiography, 6 patients were found to have single aneurysms according to cerebral angiography: the internal carotid artery – in 3 patients, the middle cerebral artery – in 2, and the pericallous artery – in 1 patient. Conclusion CT angiography is a key tool of non-invasive diagnosis of the source of SAH in emergency departments. The absence of vascular pathology on CT angiography in the presence of massive basal SAH, the detection of multiple and “complex” aneurysms, as well as cerebral arteriovenous malformations of the brain during CT angiography remain indications for cerebral angiography.

Optimizing diagnosis of obstructive coronary artery disease by CT angiography: RCT's final results and 12-months follow-up

Abstract Aim In patients (pts) with suspected coronary artery disease (CAD), computed tomographic angiography (CTA) may improve pt selection for invasive coronary angiography (ICA) as alternative to functional testing. However. the role of CTA in symptomatic pts after abnormal functional test (FT) is incompletely defined. Methods and results This randomized clinical trial conducted in single academic tertiary center selected 218 symptomatic pts with mild to moderately abnormal FT referred to ICA to receive either the originally intended ICA (n=103) or CTA (n=115). CTA interpretation and subsequent care decisions were made by the clinical team. Pts with high risk features on FT, previous acute coronary syndrome, previously documented CAD, chronic kidney disease (GFR&amp;lt;60ml/min/1.73m2) or persistent atrial fibrillation were excluded. The primary endpoint was the percentage of ICA with no significant obstructive CAD (no stenosis ≥50%) in each group. Diagnostic (DY) and revascularization (RY) yields of ICA in either group were also assessed. Pts were followed up for at least 1 year for the primary safety endpoint of all cause death/ nonfatal myocardial infarction/ stroke. Unplanned revascularization (UP) and symptomatic status (SS) were also evaluated. Pts averaged 68±9 years of age, 60% were male, 29% were diabetic. Nuclear perfusion stress test was used in 33.9% in CTA group and 31.1% in control group (p=0.655). Mean post (functional) test probability of obstructive CAD was 34%. Overall prevalence of obstructive CAD was 32.1%. In the CTA group, ICA was cancelled by referring physicians in 83 of the pts (72.2%) after receiving CTA results. For those undergoing ICA, non-obstructive CAD was found in 5 pts (15.6%) in the CTA-guided arm and 60 (58.3%) in the usual care arm (p&amp;lt;0.001 Mean cumulative radiation exposure related to diagnostic work up was similar in both groups (6±14 vs 5±14mSv, p=0.152). Both DY (84.4% vs 41.7, p&amp;lt;0.001) and RY (71.9% vs 38.8%, p=0.001) yields were significantly higher for CTA-guided ICA as compared to standard FT-guided ICA. The rate of the primary safety endpoint was similar between both groups (1.9% vs 0%, p=0.244), as well as the rates of UP (0.9% vs 0.9%, p=1.000) and SS (persistent angina: 29.6% vs 24.8%, p=0.425). Conclusions In pts with suspected CAD and mild to moderately abnormal ischemia test, a diagnostic strategy including CTA as gatekeeper is safe, effective and significantly improves diagnostic and revascularization yields of ICA. Funding Acknowledgement Type of funding source: None

Invasive- versus computed tomography-angiography for the evaluation of coronary artery disease among elderly patients undergoing transcatheter aortic valve implantation

Abstract Background Coronary artery disease (CAD) is common among elderly patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI). Current guidelines recommend that percutaneous coronary intervention (PCI) of &amp;gt;70% proximal coronary lesions prior to TAVI. The aim of the current study was to evaluate two approaches to CAD diagnosis pre-TAVI. Methods We investigated 2,027 patients undergoing TAVI for severe aortic stenosis at two large centers with different pre-procedural CAD assessment: pre-TAVI computed tomography angiography (CTA) with selective invasive angiography according to CTA results (N=831) or mandatory invasive angiography (IA) (N=1,196). Peri-procedural complications were documented according to the VARC-2 criteria. Mortality rates were prospectively documented. Results Mean age of the study population was 86±4, of whom 55% were female. Patients in the IA group had significantly higher rates of pre-TAVI PCI compared to the CTA group (32% vs. 17%, p&amp;lt;0.001). Following TAVI, peri-procedural myocardial infarction (MI) rates were significantly lower among the IA group (0.1% vs. 1.5%, p=0.001). However, multivariate binary logistic regression analysis adjusted for age, gender and cardiovascular risk factors failed to show association between centers strategy and peri-procedural MI. Periprocedural bleeding rates were similar between the groups (3.5% vs. 2.9%, p=0.477). Thirty day, and 1-year mortality crude rates were similar between the groups (2.5% vs. 3.4%, p=0.25, and 10.2% vs. 12.0%, p=0.19). Multivariate cox regression adjusted for age, gender and cardiovascular risk factors did not find association between CAD clearance strategy and outcome. Conclusions In elderly patients, CTA driven approach for CAD evaluation pre-TAVI is a valid strategy with similar outcome as compared to invasive approach. CTA strategy significantly reduces invasive procedures rates without compromising patient's outcome. Funding Acknowledgement Type of funding source: None

Intracranial and systemic atherosclerosis in the NAVIGATE ESUS trial: Recurrent stroke risk and response to antithrombotic therapy

BackgroundNon-stenotic intracranial and systemic atherosclerosis are associated with ischemic stroke. We report frequency and response to anticoagulant vs. antiplatelet prophylaxis of patients with embolic stroke of undetermined source (ESUS) who have non-stenotic intracranial atherosclerosis and/or systemic atherosclerosis. MethodsExploratory analysis of the international NAVIGATE ESUS randomized trial comparing rivaroxaban 15mg daily with aspirin 100mg daily in 7213 patients with recent ESUS. Among participants with results of intracranial arterial imaging with either computed tomographic angiography (CTA) or magnetic resonance angiography (MRA), the frequency and predictors of non-stenotic intracranial and systemic atherosclerosis and responses to antithrombotic therapy were assessed. ResultsAmong 4723 participants with available intracranial CTA or MRA results (65% of the trial cohort), the prevalence of intracranial atherosclerosis was 16% (n=739). Patient features independently associated with intracranial atherosclerosis included East Asian region (odds ratio 2.7, 95%CI 2.2,3.3) and cervical carotid plaque (odds ratio 2.3, 95%CI 1.9,2.7), among others. The rate of recurrent ischemic stroke averaged 4.8%/year among those with intracranial atherosclerosis vs. 5.0.%/year for those without (HR 0.95, 95%CI 0.65, 1.4). Among those with intracranial atherosclerosis, the recurrent ischemic stroke rate was higher if assigned to rivaroxaban (5.8%/year) vs. aspirin (3.7%/year), but the difference was not statistically significant (HR 1.6, 95%CI 0.78, 3.3). There was trend for the effect of antithrombotic treatments to be different according to the presence or absence of intracranial atherosclerosis (pinteraction=0.09). Among participants with evidence of systemic atherosclerosis by either history or imaging (n=3820), recurrent ischemic stroke rates were similar among those assigned to rivaroxaban (5.5%/year) vs. aspirin (4.9%/year)(HR 1.1, 95%CI 0.84, 1.5). ConclusionsEast Asia region was the strongest factor associated with intracranial atherosclerosis. There were no statistically significant differences between rivaroxaban and aspirin prophylaxis for recurrent ischemic stroke in patients with non-stenotic intracranial atherosclerosis and/or systemic atherosclerosis.

Relationship between Accessory Renal Artery and Clinical Characteristics of Middle-Aged Patients with Primary Hypertension

Objectives The association between accessory renal artery (ARA) and hypertension remains not fully understood. We observed the association between ARA and clinical characteristics among middle-aged patients with primary hypertension. Methods One hundred and sixty-two middle-aged (mean 39.82 ± 10.25 years, 58.0% male) patients with primary hypertension were enrolled, and patients underwent Computed Tomography Angiography (CTA) of renal arteries, ambulatory blood pressure monitor (ABPM), echocardiography, physical examination, and routine blood chemistry examinations. According to the CTA results, patients were divided into a non-ARA (n = 108) and ARA (n = 54) group. Direct renin concentration (DRC), plasma aldosterone concentration (PAC), ABPM, echocardiography, creatinine, and glomerular filtration rate were compared between the two groups. Results DRC (mU/L) (11.21 (5.34, 20.87) vs. 18.24 (10.32, 33.59), P=0.002) was significantly higher in the ARA group than in the non-ARA group. However, PAC (ng/dL) (98.30 (67.30, 134.00) vs. 116.50 (78.80, 137.25), P=0.103) was similar between these two groups. ABPM (mmHg) results showed that daytime (146.75 ± 17.04/95.86 ± 11.39 vs. 155.50 ± 14.76/100.48 ± 10.69, P < 0.05), night time (133.44 ± 17.50/85.28 ± 12.80 vs. 139.81 ± 14.64/89.83 ± 11.21, P < 0.05), and 24 h blood pressure (143.95 ± 15.99/93.90 ± 11.78 vs. 152.07 ± 13.85/98.11 ± 10.36, P < 0.05) were significantly higher in the ARA group than in the non-ARA group. Accordingly, echocardiographic-derived posterior left ventricular wall thickness value was higher in the ARA group than in the non-ARA group. Conclusion ARA is related to higher blood pressure and higher direct renin concentration in middle-aged patients with primary hypertension, and these patients deserve stricter blood pressure control. Our results provide important evidence for that ARA is a cause of hypertension and target organs damages.