Conventional Catheter Angiography Research Articles

Abstract Number ‐ 168: Conventional angiography versus non‐invasive imaging in the assessment of symptomatic carotid disease

Introduction The indication for carotid endarterectomy in symptomatic carotid stenosis of 50% or more was established based on catheter angiography. Yet, in practice, operative referral is still largely based on non‐invasive imaging. We sought to determine the discrepancy between the two modalities in our retrospective cohort. Methods We retrospectively collected data from consecutive symptomatic patients between 2019 and 2021 at our institution who were referred for evaluation and possible stenting of carotid disease based on non‐invasive imaging showing moderate to severe stenosis or occlusion. All patients underwent digitally subtracted angiography (DSA) and were treated with stenting if there was stenosis of 50% or above or if there was presence of a string sign. Otherwise, they were continued on best medical therapy. Results 98 total patients were referred for evaluation of carotid disease (Median age 60, 37% women). 21/98 were found to have a carotid occlusion on non‐invasive imaging, of those, 6 (28%) were found to have a string sign on CTA and were treated with stenting. 77/98 were found to have moderate to severe carotid artery stenosis based on non‐invasive imaging. Of those, 31 patients (40%), were not found to have significant carotid artery stenosis and were not treated with stenting. Out of total 99 patients who were referred for carotid intervention based on non‐invasive imaging, 38 (40%) patients had a change in the treatment plan. Conclusions 40% of the patients who were referred for revascularization based on non‐invasive imaging had a change in the treatment after conventional catheter angiography. Larger studies are warranted to confirm our findings.

Celiac artery compression syndrome in children

The manifestation of celiac artery compression syndrome in childhood is rarely described. At the same time, celiac artery compression syndrome remains one of the most discussed vascular diseases due to an unclear pathophysiological mechanism, difficulties in differential diagnosis, and the lack of a generally accepted algorithm for treating patients. In connection with the above, it seems relevant to analyze the features of managing children with celiac artery compression syndrome. As a result of the analysis of the scientific literature, we have come to the following conclusions: 1. Typical clinical characteristics of celiac artery compression syndrome include abdominal pain, epigastric murmur and weight loss associated with compression of the celiac artery and possibly celiac ganglia by the median arcuate ligament. 2. CT angiography and conventional catheter angiography are the gold standard for diagnosis. However, imaging findings should not be interpreted in isolation from clinical manifestations. 3. Surgical decompression of the celiac artery by resection of the median arcuate ligament is the treatment of choice for this syndrome. Both open surgery and laparoscopic techniques are safely performed with minimal morbidity and mortality. Endovascular treatment of compression celiac stenosis may have limited success.

Diagnostic Accuracy of 128-Slice Dual Source CT Coronary Angiography with Invasive Catheter Coronary Angiography in a Tertiary Care Teaching Hospital

Background: Coronary artery disease (CAD) morbidity and mortality increasing day by day in India as well as worldwide. Coronary arteries visualization by using invasive catheterization angiography is still using as a front-line diagnostic tool to evaluate the patients with CAD. 128 slice dual source CT improves the cardiac imaging such as high scanning speed, good temporal resolution and low radiation dose. Objective: To assess the diagnostic accuracy of 128-slice dual source CT cardiac angiography with conventional catheter angiography to find common arteries involved in CAD. Methods: This is a prospective, comparative, cross sectional study conducted at cardiology OPD. Patients with complaint of chest pain and suspected CAD were evaluated by CT and conventional coronary angiography and results were compared. Serum creatinine and ECG status were analyzed before the angiography. SIEMENS 128-slice Dual Source Flash Definition CT Scanner was used as a CT coronary angiography. Severity distribution of coronary artery disease, artery wise distribution of non-significant, significant lesions and coronary artery dominance pattern were analyzed and compared. Results: A total of 70 suspected CAD patients were selected and analyzed. American Heart Association (AHA) model of 17-segment was used to assess the coronary arteries. Normal angiograms reported in 15.71% patients and 58.57% had significant disease. A total of 356 lesions were identified from 690 out of 720 segments. Right coronary artery (RCA) is the most common location of significant lesions which contributes 33.5% (n=55/164). Coronary circulation of right-sided dominance was most commonly reported (70.0%). CT angiography showed 96.13% of an overall sensitivity, 96.28% specificity, 89.72% positive predictive value and 98.49% negative predictive value. Conclusion: 128-slice dual source CT scanner has showed high accuracy and act as non-invasive assessment of coronary arteries in patients with CAD Keywords: Cardiac angiography, Catheter coronary angiography, CT coronary angiography, 128-slice MDCT, Conventional angiography

Basic Arterial Anatomy and Interpretation of CT Angiography for Intra-Abdominal or Gastrointestinal Bleeding: Correlation with Conventional Angiographic Findings for Beginners

복강 내 혹은 소화기계의 활동성 출혈이 있는 경우, 원인이 되는 동맥 혈관을 파악하는 것이 중요하다. 조영증강 컴퓨터단층촬영술을 이용한 혈관조영술과 고식적인 카테터 혈관조영술에서 원인이 되는 동맥을 파악하기 위해서는 기본적인 혈관 해부학을 숙지하고 있어야 한다. 기본 해부학을 숙지하고 있다면 혈관의 기원과 주행에 다양한 변이가 있다고 하더라도 이에 대한 접근이 한결 쉬워질 것이다. 영상의학에 갓 입문한 초심자들을 대상으로 하여, 복강 내 혹은 소화기계 활동성 출혈의 원인이 될 수 있는 혈관들을 파악하는 데 도움이 될만한 기본 해부학을 설명하고자 한다.

Nontraumatic Pediatric Intracerebral Hemorrhage.

Nontraumatic Pediatric Intracerebral Hemorrhage.

The New Double-Layer Micromesh Stent (Roadsaver®): Use in Endovascular Treatment of Supraaortic and Visceral Artery Aneurysms and Pseudoaneurysms.

This study was designed to present our preliminary experience with the Roadsaver® double-layer micromesh (DLM) stent in the endovascular treatment of supra-aortic and visceral aneurysms and to utilize the flow-diverting effect of this new design in the treatment of these aneurysms. DLM stent (Roadsaver®, Terumo, Tokyo, Japan) was used in five patients (median age 61.8years; three men) for treating arterial aneurysms (one common carotid artery, one vertebral artery V1 segment, one superior mesenteric artery, and two renal artery aneurysms). All stents were successfully deployed. Follow-up imaging with conventional catheter angiography or computed tomography showed successful treatment of all aneurysms. The new DLM stent appears to be promising for the treatment of supra-aortic and visceral aneurysms.

Comparison of the Left Main Coronary Bifurcating Angle among Patients with Normal, Non-significantly and Significantly Stenosed Left Coronary Arteries

We evaluated the correlation of the left main coronary bifurcating angle (LCBA) with the severity of coronary atherosclerosis, risk factors of coronary artery disease (CAD) and the feasibility of measuring the LBCA using the axial plane. Coronary Computed tomography angiographies (CTAs) of 313 patients between Nov. 2006 and Oct. 2013 were reviewed and separated into three groups. Group I (211 patients) had significant stenosis (≥50%) of the left anterior descending coronary artery (LAD) and/or left circumflex coronary artery (LCX). Group II (62 subjects) had atherosclerosis without significant stenosis. Group III (40 subjects) had unremarkable coronary CTAs. Both Group I and II patients received conventional catheter angiography to confirm the severities of coronary stenoses. Significant differences were found among the groups with respect to risk factors, such as male gender, hypertension and body mass index. Axial plane measurement was feasible in most patients (82.1%), without significant differences among the groups. The mean LCBA was 84.7° among all patients, and significantly differed among groups I, II and III (87.34°, 81.16° and 75.53°, P < 0.001). The LCBA of group I was significantly higher than group III (P < 0.001) in univariate analysis, but insignificant in multivariate analysis (P = 0.064).

Interrupted aortic arch by multi-detector computed tomography angiography: A case report with radiological review

Interrupted aortic arch (IAA) is a rare congenital vascular malformation, which is defined as lack of luminal continuity, between the ascending and descending thoracic aorta. Many times it is associated with various congenital cardiac anomalies. Early diagnosis is mandatory to assess the patient condition and to plan medical and surgical treatment. Traditionally, chest X-ray, echocardiography, and conventional catheter angiography are the imaging tools being used. Multi-detector computed tomography (MDCT) can accurately diagnose and characterize the various forms of IAA and associated cardiac defects. We report a case of 8-year-old male child detected to have Type A IAA on MDCT with an associated ventricular septal defect and patent ductusarteriosus.

Spontaneous soft-tissue hemorrhage in anticoagulated patients: safety and efficacy of embolization.

The purpose of this study was to report the effectiveness and safety of selective arterial embolization for the management of anticoagulation-related soft-tissue bleeding. All consecutive patients from June 1, 2003, to June 1, 2010, with intractable anticoagulation-related soft-tissue bleeding treated by embolization were included. The clinical files, MDCT angiographic examinations, and procedure details were reviewed. The primary goal of this study was to report the safety and efficacy of embolization for the management of anticoagulation-related soft-tissue bleeding. The secondary goal was to evaluate the correlation between the MDCT angiography (MDCTA) findings and conventional catheter angiography. Thirty-six consecutive patients were included. All patients were under anticoagulant therapy. Overdosage of the anticoagulant was found in 12 (33%) patients. MDCT was performed with multiphasic contrast media injection in 30 patients (83%) and showed extravasation in 22 (73.3%) of those 30 patients. Catheter angiography revealed extravasation in 27 of 36 (75%) patients, and no active bleeding was observed in nine patients who were empirically embolized. The sensitivity of MDCTA for depicting ongoing active bleeding was 87%. The transfusion requirement for RBC units decreased from 4.0 (range, 0-12.0) before to 0 (range, 0-4.0) after embolization. Nine patients underwent a second embolization but only one in the same vascular territory. Eleven patients died within 30 days despite the embolization. No complications related to embolization were reported. Anticoagulation-related soft-tissue bleeding can be efficiently and safely treated by selective arterial embolization. However, this serious pathologic condition may be fatal in many cases, and rebleeding is not rare. MDCTA could help to guide treatment.

Adult ALCAPA Syndrome-Anomalous Origin of Left Coronary Artery from Pulmonary Artery: A Rare Coronary Artery Anomaly Diagnosed by 256-Slice Computed Tomography

We are presenting a rare case of anomalous origin of left coronary artery from the pulmonary artery (ALCAPA) in an adult patient. The patient underwent coronary CT angiography for exertional dyspnoea, suspected as coronary artery disease; however there were no atherosclerotic plaques. There was anomalous origin of left coronary artery from pulmonary artery. Conventional catheter angiography confirmed the origin of left coronary artery from pulmonary artery, which was retrogradely filling through right coronary artery.

Intravenous thrombolysis for ischaemic strokes: a call for reappraisal

Sir, Balami et al. (2013) state that intravenous tissue plasminogen activator thrombolysis is beneficial for the treatment of acute ischaemic stroke and that strokes are now a treatable medical emergency. A critical analysis of the data, however, raises doubts about the expansive claims of efficacy made by them and others (Wardlaw et al. , 2012). The aim of tissue plasminogen activator treatment is lysis of the thrombus and recanalization of occluded cerebral arteries, to promptly restore blood flow. To prove therapeutic efficacy of the administered thrombolytic agent, angiographic demonstration of arterial recanalization is critically important as it is the only way, in patients, to conclusively demonstrate that clot lysis has occurred. Arterial recanalization has been assessed using different methods: transcranial Doppler studies, magnetic resonance angiography, CT angiography or conventional catheter angiography. However, these tests have widely variable accuracy and reliability. Conventional catheter angiography is the reference standard because of its superb accuracy for imaging evaluation of arteries. Although transcranial Doppler studies have been frequently used to determine recanalization frequency (Alexandrov et al. , 2001, 2004; Demchuk et al. , 2001; Molina et al. , 2001; Ribo et al. , 2006; Saqqur et al. , 2007) their accuracy in assessing steno-occlusive disease is suboptimal and less than either CT angiography or magnetic resonance angiography studies (Feldmann et al. , 2007; Jauch, 2013). Time of flight magnetic resonance angiography (Neumann-Haefelin et al. , 2004; Davis et al. , 2008; Marks et al. , 2008; Kimura et al. , 2009) is limited by loss of flow signal intensity in stenotic regions (Bash et al. , 2005) and does not provide the same degree of spatial resolution as CT angiography or conventional angiography (Bash et al. , 2005; Cloft, 2005; Jauch, 2013). Overall, …

Classification, Imaging, and Interventional Procedures in Peripheral Congenital Vascular Anomalies

: Classification of vascular lesions is often confusing and various systems have been described. Pathologically, they can be classified as capillary, cavernous, venous, arteriovenous, lymphatic, and mixed types. Another pathologic classification describes them in two groups including hemangiomas and vascular malformations. Vascular lesions can also be classified for low and high flow lesions depending of blood flow velocity in the lesion. Although vascular lesions are congenital but they may not be evident until adulthood. Imaging modalities that can be used for evaluation of vascular anomalies include: conventional radiography, ultrasonography, CT Scan, MRI, catheter angiography, CT and MR angiography. MRI is the most valuable modality in the classification and diagnosis of vascular lesions. Other modalities also have important roles in diagnosis of problematic lesions and also in interventional procedures such as percutaneous treatment. Most of vascular lesions can be treated conservatively, but some of them especially high flow lesions need interventional treatment and in such lesions, usually a multidisciplinary approach is necessary. Embolization and sclerotherapy are the most used interventional techniques. The aim of this review is describing not only the multiple classification systems of peripheral vascular anomalies, but also more importantly the diagnostic role of different imaging modalities and also embolization or sclerotherapy planning for control of them.

Single Coronary Artery Anomaly: Classification and Evaluation Using Multidetector Computed Tomography and Magnetic Resonance Angiography

The aim of this study was to use multidetector computed tomography (MDCT) and magnetic resonance (MRA) angiography to illustrate the classification and clinical characteristics of single coronary artery anomaly (SCAA). Retrospective evaluation of 22 adult and pediatric patients with SCAA by way of a medical archiving system was performed between June 2001 and August 2012. Imaging modalities used for coronary artery evaluation included MRA and MDCT angiography. Of the 22 patients, the majority (n = 8; 36%) showed an interarterial course, the subtype having the worst prognosis. The retroaortic course (n = 3; 14%) and course anterior to the pulmonary trunk (n = 3; 14%) were the next most frequent patterns. Additional types (n = 8; 36%) included the following: L-I, R-III, septal, and combined. Four patients (18%) showed atherosclerotic involvement. SCAA anomaly was diagnosed as an incidental finding in the majority of patients evaluated initially for cardiovascular diseases (n = 19; 86%). Two patients (9%) required surgical interventions solely for their anomaly. Nine patients (41%) were found to have coexisting congenital heart disease. Although conventional catheter angiography is responsible for the current classification of SCAA, advanced imaging modalities are useful in the evaluation of morphological and clinical characteristics of single coronary arteries.

CT angiography in the abdomen: a pictorial review and update

The development of multidetector CT technology and helical scanning techniques has revolutionized the use of CT for primary diagnostic evaluation of the abdominal vasculature, particularly the arterial system. CT angiography has numerous benefits relative to conventional catheter angiography, and has largely replaced catheter-based techniques in many clinical algorithms. This pictorial review and update will cover important technical principles related to modern CT angiography (including contrast delivery and dose considerations), discuss relevant anatomy and variants, and illustrate numerous arterial conditions related to the abdominal aorta and branch vessels.

Patient Preferences for Coronary Computed Tomography Angiography versus Conventional Catheter Angiography for the Diagnosis of Coronary Artery Disease

The aims of the study were: 1) to assess the baseline health-related quality of life (HRQOL) of patients with coronary artery disease (CAD) using the standard gamble; 2) to evaluate and compare patients' preference for catheter versus computed tomography (CT) coronary angiography using the wait tradeoff (WTO) and rating scales; and 3) to calculate test disutility for catheter and CT coronary angiography. Thirty patients with CAD who underwent both CT and catheter angiography were interviewed by telephone within 6 months of testing. Patients were asked about their baseline symptoms and quality of life, their experience preparing for both CT and catheter angiography, their desire to undergo CT or catheter angiography, and immediate treatment versus having a waiting period between test results and treatment for a hypothetical "ideal test" with no side effects. Test disutility for CT and catheter angiography were calculated and compared. The mean and median baseline HRQOL utility values were 0.72 and 0.91. The patients were willing to wait a mean (median) time of 12 (3) days after the ideal test for the test results to avoid undergoing CT angiography. They were willing to wait a mean (median) of 7 (3) days after the ideal test for test results, to avoid undergoing catheter angiography. There was no significant difference between waiting times or between patients' rating for their experience preparing for the two tests. Test disutility for CT angiography was 1.30 quality-adjusted life days (QALD) versus 2.16 QALD for catheter angiography (P > .05). There was no significant difference in patient preference and test disutility between CT and catheter angiography in our small series. Future rigorously planned and adequately powered studies are required to confirm these findings in larger patient populations.

Prospective comparison of late 3T MRI with conventional angiography in evaluating the patency of cerebral arteriovenous malformations treated with stereotactic radiosurgery

Risk of further haemorrhage in patients suffering from arteriovenous malformation (AVM) would be eliminated only if complete obliteration of the AVM is obtained. Therefore, these patients frequently need long-term follow-up. Conventional catheter angiography (CCA) with a risk of 0.5 %.to 1.6 % of significant neurological complications has traditionally been used for this purpose. However, magnetic resonance imaging (MRI) at 3T may be a safer alternative. The aim of this study was to evaluate if MRI at 3T can accurately evaluate closure of AVM in 2 years after stereotactic radiosurgery. Twenty-three patients with both MRI at 3T and a CCA study were examined. The residual AVMs were evaluated by MRI at 3T against CCA in a prospective study. The time interval between radiosurgery and neuroimaging was on average of 25 months (range, 15-30 months) for MRI study and 33 months (range, 25-46 months) for CCA study. Ten patients showed closure of the AVM on MRI, all of which were confirmed on CCA. There was a complete agreement between late MRI at 3T scan and CCA in evaluation of AVM patency.

Computed Tomography Angiography in Acute Gastrointestinal and Intra-abdominal Bleeding in Children: Preliminary Experience

Acute gastrointestinal (GI) and intra-abdominal bleeding from different etiologies is a medical emergency with a significant morbidity and mortality. Fast detection and localization of the bleeding site are essential for effective hemostatic therapy [1]. In children with a GI bleed, it is important to assess the hemodynamic status and to establish the site of bleeding and a differential diagnosis according to the presentation and the age of the patient [2]. In trauma, a prompt diagnosis of a bleeding site can improve the efficacy of patient management [3]. Rupture and bleeding are a known presentation of solid tumours, including hepatoblastoma and hepatocellular carcinoma [4]. The most frequent causes of GI and intra-abdominal bleeding in children are shown in Table 1. The initial approach to a patient with GI bleed is endoscopy, which can be diagnostic and therapeutic. If it fails, then catheter angiography is considered. With trauma or tumoural bleeding, angiography is considered according to the diagnostic imaging workup and clinical picture. Pediatric angiography has recognized complications, which nowadays are less frequent due to the improvement in the equipment and the use of ultrasound (US) for vascular access [5]. In taking this into consideration, it is important to adequately select the group of patients that will benefit from a conventional catheter angiography in this particular clinical setting. Computed tomography angiography (CTA) has an emerging role in the diagnosis of acute GI bleed in adults. Its

Management of ruptured dissecting intracranial aneurysms in infants: report of four cases and review of the literature

Intracranial cerebral aneurysms in the pediatric population are infrequent, and those occurring in infants less than 1 year old are extremely rare. Of intracranial aneurysms in children, dissecting aneurysms are the most common type seen. While spontaneous dissecting aneurysms usually present with ischemia, hemorrhage can also occur. A retrospective review of our patients revealed that from July 1, 2007 to June 30, 2012, four infants were treated for ruptured distal dissecting intracranial aneurysms at Texas Children's Hospital. Mycotic aneurysms and collagen vascular disorder were excluded in all four cases. All patients presented in our series presented with subarachnoid hemorrhage, and three had intraventricular hemorrhage. All patients underwent conventional catheter angiography for diagnosis. All patients in this series were managed in the acute or subacute period with surgical or endovascular trapping without distal bypass procedures. All four patients tolerated sacrifice of the parent vessels feeding these distal aneurysms well. We describe the presentation and management of these rare cases and then review the current literature on the management of these dissecting aneurysms in infants.

Stroke Units and Stroke Care Services in Korea

Organized stroke care systems improve stroke outcomes, but require resources and quality-improvement programs. This study was aimed at understanding the current status of stroke care services and stroke units in Korea. An on-line survey to investigate stroke services was conducted using a structured questionnaire for physicians who were in charge of stroke services or neurology departments of Korean hospitals that had neurology resident training programs. Of the 86 neurology training hospitals in Korea, 67 (78·0%) participated in this study. Brain computed tomography and computed tomography angiography were available 24 h a day and seven days a week (24/7) in all hospitals. More than 95% of hospitals offered transcranial Doppler, carotid duplex sonography, echocardiography, and conventional catheter angiography. Intravenous thrombolysis and hemicraniectomy for ischemic brain edema were provided 24/7 in all hospitals, and 50 hospitals (74·6%) were capable of intra-arterial thrombolysis. Stent or angioplasty was more frequently performed than endarterectomy. Performance measures were monitored in 57 hospitals (85·1%). Twenty-nine (43·3%) hospitals had stroke units. Stroke units were more common as the number of beds in the hospital increased (P = 0·001). When compared with hospitals without stroke units, stroke coordinators, use of general management protocol and education program for stroke team were more frequently available in the hospitals with stroke units. Most neurology training hospitals in Korea offered competent acute stroke care services. However, stroke units have not been widely implemented. Encouragement and support at the government or national stroke society level would promote the implementation of stroke units with little additional effort.

Abstract 3780: MR Imaging Of The Intracranial Vessel Wall In Paediatric Stroke

Background Arteriopathy in childhood arterial ischaemic stroke (AIS) is common and is postulated to be a predictor of outcome. The distinction between inflammatory (transient cerebral arteriopathy [TCA], CNS angiitis) and non-inflammatory (arterial dissection, moyamoya) arteriopathies is vital to guide acute management decisions. Currently available non-invasive angiographic imaging techniques are inadequate to reliably distinguish inflammatory from non-inflammatory causes. Conventional catheter angiography, the gold standard, is invasive and not always feasible. Objective: To report the findings of a novel non-invasive arterial wall MR imaging technique in three children with arterial ischemic stroke due to arteriopathy. Method: 3-Tesla T1-weighted 2D FLAIR fast spin echo sequence (slice thickness 3mm, matrix size 512x512) in plane and perpendicular to the vessel of interest were performed in three children with AIS before and after intravenous administration of Gadolinium, in addition to routine sequences. Results: The first child had TCA ( Fig. 1 ), the second had arterial dissection and the third had CNS angiitis (see table ). Conclusion: Our series highlights the utility of a novel non-invasive MR imaging technique of vessel wall as distinct patterns of vessel wall enhancement could be demonstrated in children with TCA, arterial dissection and CNS angiitis. Prospective studies are required to further assess the diagnostic utility of vessel wall enhancement in children with arteriopathy-related AIS. This would also help us understand the pathophysiologic mechanism of this finding. Table 1. y=years; F=female; M=male; dICA=distal internal carotid artery; BA=basilar artery