Diagnostic Neuroangiography Research Articles

‘The Closer’-percutaneous vascular suture device: evaluation of safety and performance in neuroangiography

Objective: To evaluate the use of the suture mediated vascular closure device concerning practicability and safety in clinical angiography practice. Material and methods: One hundred and seventeen patients (59 female, 58 male, mean age 40.9±13.4) underwent percutaneous closure of common femoral arterial puncture sites following diagnostic neuroangiography using the suture device ‘the Closer’ (Perclose Inc., Redwood City, CA, USA). Primary success, early problems (within 24 h) and late complications were evaluated. Complications were graded as minor and severe with or without need of surgical intervention and categorized by type. Parameters such as age, gender, sheath size and number of previous arterial punctures were evaluated with respect to complications. Results: Percutaneous closure was primary successful in 85% (100/117). The overall complication rate was 32% (28% mild n=35, 4% severe n=6, which needed surgical intervention). All but one problem occurred within the first 24 h after the suture. Additional manual compression was necessary in 32 cases (25%). There was no significant difference in age and gender between the groups with and without complications. Sheath size was significantly larger ( P<0.01) and numbers of preceeding angiograms were significantly higher ( P<0.01) in the complications group compared with uncomplicated cases. Conclusion: The evaluated percutaneous vascular suture device is useful in clinical practice but limitations concerning patient selection seem to emerge in order to avoid complications.

Quality Improvement Guidelines for Adult Diagnostic Neuroangiography

NEUROANGIOGRAPHY is a safe and effective technique for evaluating various intracranial and extracranial disorders. The diagnostic information obtained by neuroangiography, combined with other clinical and noninvasive imaging findings, can be used to plan or evaluate results of treatment.

Radiation Dose and Image Quality in Neuroangiography: Effects of Increased Tube Voltage, Added X-Ray Filtration and Antiscatter Grid Removal

During endovascular treatment the patient may be subject to fluoroscopy for long periods as well as multiple x-ray exposures. The radiation dose to the patient can be considerable, and cause local deterministic effects such as alopecia or even skin burn. The potential carcinogenic effects should also be noted, being especially important in the paediatric population. We measured radiation doses to patients and personnel during neuroendovascular procedures and diagnostic neuroangiography. We also tried to reduce the radiation dose to the patient utilising increased tube voltage, additional primary X-ray filtration and by removing the antiscatter grid in front of the image intensifier, employing air gap technique. We investigated radiation doses to patient and personnel during neuroangiographic procedures and optimized the examination technique with regard to radiation dose with maintained image quality. Radiation exposure to patients and personnel was measured with thermoluminescent dosimeters and permanently mounted KermaDoseArea-Product meters in front of the X-ray tubes during 13 cerebral angiographies and six neuroendovascular procedures. We performed experiments with radiation dose measurements and evaluation of image quality with 80 and 90 kV tube voltage during image acquisition and 75 and 85 kV during fluoroscopy, as well as with different primary X-ray filtration. Images from patient studies acquired with the original grid in front of the image intensifier were compared with images from patient studies acquired with the grid removed and air gap technique (30 cm). Images from patient studies acquired with the original examination technique were compared to images from patient studies acquired with increased x-ray tube voltage, increased x-ray filtering and with the antiscatter grid removed using an airgap as scatter reduction method. Radiation exposure to personnel was very low using standard protective devices. Measurable doses were recorded only on the hands and forehead of the neuroradiologist. Maximum entrance skin dose was about 1 Gy on the side of the patientspatient's forehead during an endovascular procedure. Increasing the tube voltage from 75 to 85 - 85 and 90 kV, exchanging the original 0.5 mm aluminium primary filtration for 0.2 mm copper and removing the antiscatter grid allowed us to reduce entrance skin dose to the patient by 70% with unchanged or slightly improved image quality.

Spontaneous carotid-cavernous fistulae in Ehlers-Danlos syndrome Type IV

Spontaneous bilateral carotid-cavernous fistulae and cervical artery dissection is reported in a 20-year-old woman with Ehlers-Danlos syndrome Type IV. The clinical features of 16 previously published cases of spontaneous carotid-cavernous fistulae associated with Ehlers-Danlos syndrome Type IV are reviewed, for a total of 17 cases. The mean age of the 14 women and three men was 31.6 years. Only direct fistulae were encountered. Diagnostic neuroangiography carried morbidity and mortality rates of 36% and 12%, respectively; neuroradiological treatment resulted in death in one of six patients. The possible value of desmopressin in the management of these patients is discussed. In view of the risks of arterial puncture and surgery, the authors emphasize the importance of early recognition of Ehlers-Danlos syndrome.