Tomography Angiography In Evaluation Research Articles

Long-term graft patency after coronary artery bypass grafting: Effects of surgical technique.

The aim of the current study was to identify surgical factors associated with long-term patency of grafts used in coronary artery bypass grafting (CABG). The present study analyzed data from 127 patients who underwent CABG at our institute between 2000 and 2006 and presented for ambulatory examination and coronary computed tomography angiography evaluation of graft patency in 2016 (139.78±36.64 months post-CABG). The 127 patients received 340 grafts (2.68 grafts/patient) and 399 distal anastomoses (3.14 anastomoses/patient), 220 (55.14%) with arterial grafts and 179 (44.86%) with saphenous vein grafts. Graft patency varied according to coronary territory, proximal anastomosis type (in situ graft, composite graft, graft anastomosed to the ascending aorta), Y anastomosis angle (47.21° for patent arterial grafts vs. 56° for occluded), and distal anastomosis angle (in sequential anastomoses irrespective to graft type, 48.60° for patent side-to-side anastomosis vs. 53.97° for occluded, 65.12° for patent end-to-side anastomosis vs. 90.80° for occluded; in single end-to-side anastomosis of arterial grafts, 39.46° for patent and 44.94° for occluded). A single end-to-side anastomosis angle 60° or greater was associated with a 5.149 occlusion odds ratio (OR) (P<0.001) for arterial grafts. Venous grafts were not sensitive to single end-to-side anastomosis angle. In conclusion, a small anastomosis angle for proximal Y and distal anastomoses is associated with a higher long-term patency of the free graft. Radial artery grafts registered higher patency rates when anastomosed to the ascending aorta compared with composite grafting with the left internal thoracic artery, whereas in situ right internal thoracic artery (RITA) anastomosed to the right coronary territory is associated with a lower patency rate compared with free RITA used to revascularise the anterolateral or circumflex territory in composite grafting.

Computed tomography angiography evaluation of acute limb ischemia.

Acute limb ischemia (ALI), a subclass of critical limb ischemia, is a medical emergency. The cause of ALI is usually thrombotic or embolic in nature, and the specific etiology often dictates the appropriate therapy. While the diagnosis is a clinical with common presenting symptoms, advances in ultrasound, computed tomography, and magnetic resonance technology have impacted the diagnosis and subsequent therapy. In ALI, the time to revascularization is critical and computed tomography angiography (CTA) provides a highly sensitive and specific technique for rapidly identifying occlusions and precisely defining vascular anatomy prior to interventions. In patients with significant renal disease, magnetic resonance angiography with or without contrast provides effective alternatives at the expense of imaging time. Treatment can include a variety of endovascular or surgical interventions, including thromboembolectomy, angioplasty, or bypass. Proper evaluation of the etiology of the ischemia, affected vasculature, and medical history is critical to select appropriate treatment and improve patient outcomes. Here, we examine the presentation, evaluation, and treatment of ALI and the role of CTA in diagnosis and therapy.

Influence of symptom typicality for predicting MACE in patients without obstructive coronary artery disease: From the CONFIRM Registry (Coronary Computed Tomography Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry).

Our objective was to assess the prognostic value of symptom typicality in patients without obstructive coronary artery disease (CAD), determined by coronary computed tomographic angiography (CCTA). We identified 4215 patients without prior history of CAD and without obstructive CAD (<50% CCTA stenosis). CAD severity was categorized as nonobstructive (1%-49%) and none (0%). Based upon the Diamond-Forrester criteria for angina pectoris, symptom typicality was classified as asymptomatic, nonanginal, atypical, and typical. Multivariable Cox proportional hazards models were used to assess the risk of major adverse cardiac events (MACE), comprising all-cause mortality, myocardial infarction, unstable angina, and late revascularization, according to symptom typicality. Mean patient age was 57.0 ±12.0 years (54.9% male). During a median follow-up of 5.3 years (interquartile range, 4.6-5.9 years), MACE were reported in 312 (7.4%) patients. Among patients with nonobstructive CAD, there was an association between symptom typicality and MACE (P for interaction = 0.05), driven by increased risk of MACE among those with typical angina and nonobstructive CAD (hazard ratio: 1.62, 95% confidence interval: 1.06-2.48, P = 0.03). No consistent relationship was found between symptom typicality and MACE among patients without any CAD (hazard ratio: 0.73, 95% confidence interval: 0.34-1.57, P = 0.08). In the CONFIRM registry, patients who presented with concomitant typical angina and nonobstructive CAD had a higher rate of MACE than did asymptomatic patients with nonobstructive CAD. However, the presence of typical angina did not appear to portend worse prognosis in patients with no CAD.

Computed Tomography Angiography Evaluation of Risk Factors for Unstable Intracranial Aneurysms

To evaluate risk factors for instability in intracranial aneurysms (IAs) using computed tomography angiography (CTA). A total of 614 consecutive patients diagnosed with 661 IAs between August 2011 and February 2016 were reviewed. Patients and IAs were divided into stable and unstable groups. Along with clinical characteristics, IA characteristics were evaluated by CTA. Multiple logistic regression analysis was used to identify the independent risk factors associated with unstable IAs. Receiver operating characteristic (ROC) curve analysis was performed on the final model, and optimal thresholds were obtained. Patient age (odds ratio [OR], 0.946), cerebral atherosclerosis (CA; OR, 0.525), and IAs located at the middle cerebral artery (OR, 0.473) or internal carotid artery (OR, 0.512) were negatively correlated with instability, whereas IAs with irregular shape (OR, 2.157), deep depth (OR, 1.557), or large flow angle (FA; OR, 1.015) were more likely to be unstable. ROC analysis revealed threshold values of age, depth, and FA of 59.5 years, 4.25 mm, and 87.8°, respectively. The stability of IAs is significantly affected by several factors, including patient age and the presence of CA. IA shape and location also have an impact on the stability of IAs. Growth into an irregular shape, with a deep depth, and a large FA are risk factors for a change in IAs from stable to unstable.

Fundus Fluorescein Angiography Versus Optical Coherence Tomography Angiography in Evaluation of Retinal Changes in Cases of Retinal Vein Occlusion

AbstractBackground: Retinal Vein Occlusion (RVO) is the second most common retinal vascular disease and the fifth common cause of visual loss worldwide. Fundus Fluorescein Angiog-raphy (FFA) is the gold standard investigation for its evaluation. However, it has some limitations. Optical Coherence Tomog-raphy Angiography (OCTA) is a novel technique for evaluation of retinal vascular changes. It may overcome some of the limitations of FFA.Objective: Comparison between FFA and OCTA in eval-uation of retinal changes in retinal vein occlusion.Methods: This prospective observational case series study was carried out on 30 eyes of 29 patients attending Ophthal-mology Outpatient Clinic in Tanta University Hospital from July 2016 to May 2017. FFA and OCTA were done to all patients at time of diagnosis. The results of both modalities were compared regarding macular ischemia, macular edema, microaneurysms, collaterals and neovascularizations.Results: OCTA detected macular ischemia in the superficial plexus of 17 cases while it detected ischemia in the deep plexus of 25 cases. FFA detected macular ischemia in 9 cases and couldn't comment on ischemia in 5 cases. FFA detected macular edema in 23 cases while OCTA detected only 20 cases. Both collaterals and neovascularizations were detected in 3 separate cases by both OCTA and FFA. Microaneurysms were detected in 8 cases by FFA and in 4 cases by OCTA.Conclusion: OCTA was superior to FFA in detection of macular ischemia. Both modalities were equal in detection of macular edema, collaterals and neovascularizations. FFA was superior in detection of microaneurysms.

VASCULAR DISTORTION AND DRAGGING RELATED TO APPARENT TISSUE CONTRACTION IN MACULAR TELANGIECTASIS TYPE 2.

To examine the alterations in retinal vascular morphology over an extended follow-up in eyes with macular telangiectasis Type 2 (MacTel2). Eyes with high-quality digital photographs were evaluated. The geometric distortion in baseline images required to emulate the follow-up images was determined and vectors were made that represented the direction and magnitude of changes, to create a warp field. Optical coherence tomography and optical coherence tomography angiography evaluation of the retina was performed. There were 7 eyes of 4 patients, who had a mean age of 70.25 years, which were followed for a mean of 8.8 years. The eyes showed increasing grayish opacification in the temporal macula with straightening and displacement of the macular vessels, even those in the nasal macula. The warp field vectors pointed to the temporal juxtafoveal macula. There was never any cavitation at the epicenter of the retinal distortion in any patient, although cavitations were found around this area. Optical coherence tomography imaging showed a circumscribed region of hyperreflectivity in the temporal macula. Optical coherence tomography angiography showed a deep angular condensed network of vessels within the hyperreflective region. One eye showed marked atrophic changes including full-thickness macular hole formation, but no increase in graying of the retina, loss of retinal laminations, pigmentary infiltration, or alteration in the retinal vessels. Tissue contraction with retinal vascular displacement and contortion seem to be integral aspects of disease manifestation in MacTel2. The induced vascular changes may lead to secondary effects that increase morbidity in this disease.

Optical Coherence Tomography Angiography in the Evaluation of Geographic Atrophy Area Extension.

To investigate the application of optical coherence tomography angiography (OCT-A) in evaluation of geographic atrophy (GA) secondary to age-related macular degeneration (AMD). Patients with GA were prospectively enrolled and studied with blue fundus autofluorescence (FAF), en face structural OCT, and OCT-A. OCT-A images were acquired using a slab of whole choroid, whereas en face structural OCT images were obtained at the ellipsoid zone (EZ), at the choroidal (CH) level, and at the scleral (SC) level. Three readers independently measured the GA extension areas and evaluated the foveal sparing in each examination. Intraobserver/interobserver agreements and agreement between each couple of imaging techniques were assessed. A total of 47 eyes (26 patients, mean age 76 ± 7 years) with GA (mean area using FAF: 8.77 ± 5.00 mm2) were included. Intraobserver and interobserver agreement was excellent for all imaging techniques (intraclass correlation coefficient [ICC] > 0.985), even if en face EZ structural OCT revealed the poorest quality agreement limits. Considering the analysis between each couple of imaging techniques, ICC was excellent between OCT-A compared with FAF (ICC: 0.995), followed by en face structural OCT at CH level (ICC: 0.992), at SC level (ICC: 0.986), and at EZ level (ICC: 0.973). No differences were detected between multifocal and monofocal GA lesions. Considering the evaluation of foveal involvement, lower agreements were disclosed between FAF and all other imaging techniques. OCT-A is a reliable technique for easily visualizing and quantifying GA with the advantages, compared to current imaging techniques, of offering together both structural and blood flow information regarding retinal and choroidal layers and excluding choroidal neovascularization.

Application of optical coherence tomography angiography in evaluation of retinal microvascular changes in patients with obstructive sleep apnea syndrome

Objective: To assess the changes of retinal microvasculature in patients with obstructive sleep apnea syndrome (OSAS) evaluated by optical coherence tomography (OCTA). Methods: Adult OSAS patients who visited Beijing Tongren Hospital from Jan 2016 to Apr 2016 and complained of snoring were included in this study. The patients' general information, results of polysomnography, and OCTA parameters were collected. Patients were divided into three groups according to their apnea hypopnea index (AHI) results: Mild-moderate group, AHI≤30/h; Severe group, 30/h<AHI≤60/h; Extremely severe group, AHI>60/h, and clinical characteristics, polysomnography and OCTA parameters among the three groups were compared. Results: A total of 27 patients were included in this study with 21 males (77.8%) and 6 females (22.2%). Mean age was (41.7±10.0) years, and the mean body mass index was (27.9±4.5) kg/m(2;) Neck circumference was 31-48 cm, mean (39.8±4.3) cm; 8 patients (29.6%) suffered from hypertension that could be controlled; Epworth sleepiness scale scored 1-18 points and mean (8.5±4.4) scores; AHI ranged between 5.5 and 92.1/h with a mean of (46.4±28.6)/h. There were 9 (33.3%), 7 (25.9%), and 11 (40.7%) patients in mild-moderate group, severe group, and extremely severe group, respectively. Compared with severe group, the optic nerve head and radial peripapillary capillaries (RPC) peripapillary vascular density in extremely severe group were significantly decreased (62.4%±1.9% vs 60.3%±1.9%, P=0.041; 64.7%±1.7% vs 62.2%±2.3%, P=0.036). Conclusions: OCTA has rapid, safe, and objective characteristics in assessing the retinal microvascular changes in OSAS patients. Retinal microvascular damage in patients with OSAS is associated with the disease severity. Reduction of retinal microvascular density in patients with OSAS may be associated with intermittent hypoxia.

Prospective, multicenter study of endovascular repair of aortoiliac and iliac aneurysms using the Gore Iliac Branch Endoprosthesis

ObjectiveThe GORE EXCLUDER Iliac Branch Endoprosthesis (IBE; W. L. Gore and Associates, Flagstaff, Ariz) is an iliac branch stent graft system designed to preserve internal iliac artery perfusion during endovascular repair of aortoiliac aneurysms (AIAs) and common iliac artery (CIA) aneurysms (CIAAs). We report the 6-month primary end point results of the IBE 12-04 United States pivotal trial for endovascular treatment of AIAs and CIAAs using the IBE device. MethodsThe trial prospectively enrolled 63 patients with AIA or CIAA who underwent implantation of the IBE device at 28 centers in the United States from 2013 to 2015. All patients underwent placement of a single IBE device. Twenty-two patients (34.9%) with bilateral CIAs were enrolled after undergoing staged coil or plug embolization (21 of 22) or surgical revascularization (1 of 22) of the contralateral internal iliac artery. Follow-up at 30 days and 6 months included clinical assessment and computed tomography angiography evaluation as assessed by an independent core laboratory. The primary effectiveness end point was freedom from IBE limb occlusion and reintervention for type I or III endoleak and ≥60% stenosis at 6 months, and the secondary effectiveness end point was freedom from new onset of buttock claudication on the IBE side at 6 months. ResultsMean CIA diameter on the IBE side was 41.0 ± 11.4 mm (range, 25.2-76.3 mm). There were no procedural deaths, and technical success, defined as successful deployment and patency of all IBE components and freedom from type I or III endoleak, was 95.2% (60 of 63). Data for 61 patients were available for primary and secondary effectiveness end point analysis. Internal iliac limb patency was 95.1% (58 of 61), and no new type I or III endoleaks or device migrations were observed at 6 months. The three patients with loss of internal iliac limb patency were asymptomatic, and freedom from new-onset buttock claudication on the IBE side was 100% at 6 months. New-onset buttock claudication occurred on the non-IBE treatment side in six of 21 patients (28.6%) who underwent staged internal iliac artery coil embolization. ConclusionsThese results confirm that the IBE device is effective at treating CIAAs and AIAs, maintaining blood flow into the internal iliac artery, and avoiding complications associated with internal iliac artery sacrifice. Follow-up will be continued for 5 years to establish the long-term durability of iliac aneurysm repair with the IBE device.

Instantaneous wave-free ratio derived from coronary computed tomography angiography in evaluation of ischemia-causing coronary stenosis: Feasibility and initial clinical research.

The instantaneous wave-free ratio (iFR) closely related to fractional flow reserve (FFR) is a adenosine-independent physiologic index of coronary stenosis severity. We sought to evaluate whether iFR derived from coronary computed tomographic angiography (iFRCT) can be used as a novel noninvasive method for diagnosis of ischemia-causing coronary stenosis.We retrospectively enrolled 33 patients (47 lesions) with coronary artery disease (CAD) and examined with coronary computed tomographic angiography (CTA), invasive coronary angiography (ICA), and FFR. Patient-specific anatomical model of the coronary artery was built by original resting end-diastolic CTA images. Based on the model and computational fluid dynamics, individual boundary conditions were set to calculate iFRCT as the mean pressure distal to the stenosis divided by the mean aortic pressure during the diastolic wave-free period of rest state. Ischemia was assessed by an FFR of up to 0.8, while anatomically obstructive CAD was defined by a stenosis of at least 50% by ICA. The correlation between iFRCT and FFR was evaluated. The receiver operating characteristic (ROC) curve was used to select the cut-off value of iFRCT for diagnosis of ischemia-causing stenosis. The diagnostic performances of iFRCT, coronary CTA, and iFRCT plus CTA for ischemia-causing stenosis were compared with ROC curve and Delong method.On a per-vessel basis, iFRCT and FFR had linear correlation (r = 0.75, p < 0.01). ROC analysis identified an optimal iFRCT cut-off value of 0.82 for categorization based on an FFR cut-off value 0.8, and the diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of iFRCT were 78.72%,70.59%, 83.33%,70.59%, and 83.33%, respectively. Compared with obstructive CAD diagnosed by coronary CTA (AUC = 0.60), iFRCT yielded diagnostic improvement over stenosis assessment with AUC increasing from 0.6 by CTA to 0.87 (P < 0.01) and 0.90 (P < 0.01) when iFRCT plus CTA.In conclusion, iFRCT is a promising index improving diagnostic performance over coronary CTA for detection of ischemia-causing coronary stenosis.

The Potential Role of Combined Highly Sensitive Troponin and Coronary Computed Tomography Angiography in the Evaluation of Patients with Suspected Acute Coronary Syndrome in the Emergency Department

The evaluation and triage of patients presenting to the emergency department (ED) with suspected acute coronary syndrome (ACS) remains to be challenging despite available guidelines and clinical evidence. The current guidelines in the USA recommend clinical risk assessment based on cardiovascular risk factors followed by serial electrocardiograms and conventional cardiac troponin measurements, which are supplemented by advanced non-invasive cardiac testing in the majority of patients. This approach is safe, but leads to a lengthy work-up and high cost of care. There is clinical need for diagnostic strategies that will lead to rapid and reliable triage of patients with suspected ACS. In this review, we will summarize the experience and evidence for the use of highly sensitive troponin (hsTn) in the rapid and efficient evaluation of patients with suspected ACS. We will also review the available literature on the use of coronary computed tomography angiography (CTA) in the rapid evaluation of patients with suspected ACS. We will discuss the opportunities for the combined use of hsTn and coronary CTA in this population. Finally, we will outline the possible implementation of combined use of hsTn and coronary CTA in the evaluation of patients with suspected ACS in the ED.

Results of celiac trunk stenting during fenestrated or branched aortic endografting

BackgroundEndovascular repair of aortic aneurysms involving the visceral segment of the aorta often requires placement of a covered bridging stent in the celiac axis (CA). The median arcuate ligament (MAL) is a fibrous arch that unites the diaphragmatic crura on either side of the aortic hiatus. The ligament may compress and distort the celiac artery and result in difficult cannulation, or stenosis and occlusion of the vessel. This study evaluated the influence of the MAL compression on the technical success and the patency of the celiac artery after branched and fenestrated endovascular aortic repair. MethodsWe retrospectively analyzed a cohort of consecutive patients treated electively for complex aneurysms with branched and fenestrated endovascular aortic repair between January 2007 and April 2014. All data were collected prospectively. Analysis of preoperative computed tomography angiography on a three-dimensional workstation determined the presence of MAL compression. Patency of the CA bridging stent was assessed during follow-up by computed tomography angiography and duplex ultrasound evaluation. Statistical analysis was performed to compare the outcomes of patients with MAL (MAL+) and without MAL (MAL-) compression. ResultsOf 315 patients treated for aortic disease involving the visceral segment during the study period, 113 had endografts designed with a branch (n = 57) or fenestration (n = 56) for the CA. In 45 patients (39.8%), asymptomatic compression of the CA by the MAL was depicted (MAL+). Complex endovascular techniques were required in this group to access the CA in 16 (14.2%) patients (vs none in the MAL- group; P = .003), which lead to a failed bridging stent implantation in seven patients (6.2%). Increased operative time and dose area product were observed in the MAL+ group, but this did not reach statistical significance. In the MAL+ group, no thrombosis of the CA bridging stents were observed during follow-up; an external compression of the CA bridging stent was depicted in six patients but without hemodynamic effect on duplex ultrasound imaging. In the MAL- group, one CA bridging stent occlusion occurred owing to an embolus from a cardiac source. ConclusionsMAL compression is associated with good celiac trunk bridging stent patency during follow-up, but with a higher rate of technical difficulties and failed bridging stent implantation during the procedure.

Optical Coherence Tomography Angiography Evaluation of the Parafoveal Vasculature and Its Relationship With Ocular Factors

To determine the size and characteristics of the superficial and deep foveal avascular zone (FAZ) in healthy adults by using optical coherence tomography angiography (OCT-A), and to ascertain the effects of demographic and ocular parameters on the FAZ size. In a prospective cohort study of 117 healthy volunteers, foveal-centered 3 × 3-mm OCT-A scans were manually graded by certified graders to determine the size of the superficial and deep FAZ. Multiple linear regression analyses were performed to evaluate the impact of demographics and ocular factors, including central retinal thickness (CRT), choroidal thickness, axial length (AL), and spherical equivalent (SE) on superficial and deep FAZ areas. The mean age of the participants was 22.5 years, with mean AL of 25.4 mm and mean SE of -4.3 diopters. The mean CRT was 262.8 μm (range, 220-316 μm). The mean superficial FAZ area was 0.24 mm2, while the deep FAZ area was 0.38 mm2 (P < 0.001). Females had a larger superficial (P < 0.001) and deep FAZ (P < 0.001). On univariate linear regression, both superficial and deep FAZ areas had significant correlations with CRT, sex, AL, and SE, but not with age. By multiple linear regression analysis, in normal eyes, superficial FAZ area varied significantly with CRT and sex. Among eyes with high myopia, both superficial and deep FAZ varied significantly with CRT, sex, and choroidal thickness. The superficial and deep FAZ areas varied significantly among healthy eyes. Factors such as CRT, sex, SE, AL, and choroidal thickness influence the size of the FAZ.

29. Triple rule out versus standard coronary computed tomography angiography in evaluation of acute chest pain syndrome.

Acute chest pain (ACP) in emergency department represents a health care challenge. Triple-rule-out (TRO) Computed Tomography Angiography (CTA) can provide an evaluation of the coronary arteries, aorta,Pulmonary arteries, and chest structures in one scan. The aim of our work was to evaluate the diagnostic yield of TRO versus cardiac CTA in patients with ACP, In addition to compare the image quality, contrast material and radiation doses of TRO with standard CTA.We hypothesized that TRO CTA has a comparable diagnostic yield to standard coronary CTA, in addition to its ability to add extra diagnostic information. Prospective analysis of 134 TRO CTA data, to assess the presence of coronary artery disease(CAD), Aortic dissection, pulmonary embolism and other chest pathology. Then retrospectively to compare the results with 132 standard CTA. Normal coronaries or non-significant CAD was seen in 97 (72.9%) patients, 19 (14.2%) had moderate or significant CAD, two (1.5%) had aortic dissection, three (2.2%) had a pulmonary embolism, 61% had other findings. The image quality score and noise were comparable between the standard and TRO CTA (2.8 ± 0.6 vs 2.96 ± 0.6, P = 0.28) and (30.5 ± 10.6 vs 28.4 ± 1, P = 0.1) respectively. The effective radiation dose was significantly lower in the standard compared to the TRO CTA using prospective (4.4 ± 1.7 vs. 5.1 ± 0.5 mSv = 0.008) and (11.9 vs. 18.3 ± 5 msv, P = 0.0001) for retrospective gating protocols. The contrast dose was lower with standard protocol (83 ± 5 vs 102 ± 9 ml. p = 0.001). TRO CTA is a valid tool for diagnosis of CAD and can provide accurate detection of non-coronary pathology, but it was associated with higher radiation and contrast doses compared to the standard CTA.

FT21. Results of Celiac Trunk Stenting During Fenestrated or Branched Aortic Endografting

Endovascular repair of aortic aneurysms involving the visceral segment of the aorta often requires placement of a covered bridging stent in the celiac trunk (CT). The median arcuate ligament (MAL) is a fibrous arch that unites the diaphragmatic crura on either side of the aortic hiatus. The ligament may compress and distort the celiac artery and result in difficult cannulation or stenosis and occlusion of the vessel. This study evaluated the influence of MAL compression on the technical success and the patency of the celiac artery after branched and fenestrated endovascular aortic repair (BEVAR and FEVAR). We retrospectively analyzed a cohort of consecutive patients treated electively for complex aneurysms with BEVAR and FEVAR between January 2007 and April 2014. All data were collected prospectively. Analysis of preoperative computed tomography angiography on a 3D-workstation determined the presence of MAL compression. Patency of the CT bridging stent was assessed during follow-up by computed tomography angiography and duplex ultrasound evaluation. Statistical analysis was performed to compare the outcomes of patients with (MAL+) and without MAL (MAL−) compression. Of 315 patients treated for aortic disease involving the visceral segment during the study period, 113 had endografts designed with a branch (n = 57) or fenestration (n = 56) for the CT. In 45 patients (39.8%), an asymptomatic compression of the CT by the MAL was depicted (MAL+). Complex endovascular techniques were required in this group to access the CT in 16 (14.2%) patients (vs none in the MAL− group; P = .003), which led to a failed bridging stent implantation in 7 patients (6.2%). Increased operative time and dose area product were observed in the MAL+ group but this did not reach statistical significance. In the MAL+ group, no thrombosis of the CT bridging stents were observed during follow-up; an external compression of the CT bridging stent was depicted in 6 patients but without hemodynamic effect on duplex ultrasound imaging. In the MAL− group, one CT bridging stent occlusion occurred due to an embolus from a cardiac source. MAL compression is associated with good CT bridging stent patency during follow-up but with a higher rate of technical difficulties and failed bridging stent implantation during the procedure.

Utility of Multidetector Computed Tomography Angiography in evaluation of post traumatic neglected vascular injuries of the upper extremity

BackgroundVascular injuries of the upper limb are rare, and CT angiography (CTA) may be performed to assess vascular complications in neglected trauma patients. ObjectivesThe aim of this study was to evaluate the role of CTA in evaluation of neglected vascular injuries. Subjects & methodsThis prospective study included 20 patients with previous trauma history, with clinically suspected vascular lesion. CTA was done for all patients followed by surgical treatment. ResultsCTA detects pseudoaneurysm in 11 (55%) patients, stenosis in 5 (25%) patients, total occlusion in 2 (10%) patients, and arteriovenous fistula (AVF) in 2 (10%) patients. One patient (5%) had metallic artifact that alters image interpretation. The accuracy of CTA in detecting vascular lesion in the examined patients was 95% with sensitivity and specificity of 95% and 100%, respectively. ConclusionsMDCT angiography is highly accurate initial noninvasive diagnostic tool for the evaluation of vascular abnormalities of the upper extremity arterial system in patients with suspected neglected extremity trauma. Limitation of CTA examination was the presence of metallic artifact adjacent to the examined arteries.

Triple rule out versus standard coronary computed tomography angiography in evaluation of acute chest pain syndrome. A single center study from Prince Sultan Cardiac Centre, Qassim

Triple rule out versus standard coronary computed tomography angiography in evaluation of acute chest pain syndrome. A single center study from Prince Sultan Cardiac Centre, Qassim

Results of the Nellix system investigational device exemption pivotal trial for endovascular aneurysm sealing

The Nellix EndoVascular Aneurysm Sealing system (Endologix, Inc, Irvine, Calif) is a novel approach to abdominal aortic aneurysm (AAA) endovascular repair whereby biocompatible polymer is employed to exclude and to seal the AAA sac. We report 30-day results of the U.S. pivotal trial. Consecutive, eligible, consenting patients were enrolled at 29 sites in the United States and Europe. Inclusion criteria required an asymptomatic infrarenal AAA, with aortic neck length ≥10 mm and angle to the sac ≤60 degrees, aortic neck diameter of 18 to 32 mm, aneurysm blood lumen diameter ≤6 cm, common iliac artery lumen diameter of 9 to 35 mm, access artery diameter ≥6 mm, and serum creatinine level ≤2 mg/dL. Follow-up at 30 days included clinical assessment and computed tomography angiography evaluation of endoleaks and device integrity as assessed by a core laboratory. The primary safety end point is the incidence of independently adjudicated 30-day major adverse events (MAEs), with success defined as superiority with reference to the Society for Vascular Surgery open repair control group (56%). Between January and November 2014, 150 trial patients having a mean AAA diameter of 5.8 cm were enrolled and treated with the Nellix system with 100% procedural success. One early death (0.7%) occurred secondary to multisystem organ failure. All 149 surviving patients completed 30-day follow-up. There were no aneurysm ruptures, conversions, limb thromboses, stent fractures, or stent kinking. Five early MAEs occurred in four patients (2.7%) and included one death, bowel ischemia (1), renal failure (2), and respiratory failure (1). One (0.7%) secondary intervention to treat inadvertent coverage of a renal artery was performed. The core laboratory identified nine (6%) endoleaks (one type I, eight type II) on 30-day computed tomography angiography. Freedom from MAE was 97.3% (95% confidence interval, 93.3%-99.0%). In selected patients, perioperative outcomes with the Nellix system for endovascular aneurysm sealing are encouraging, with very low 30-day morbidity and mortality and high procedural success. The primary safety end point has been achieved. Longer term follow-up is in progress.

GW26-e3907 Diagnostic accuracy of 320-slice dynamic volume computed tomography angiography for evaluation of coronary stent patency and restenosis

GW26-e3907 Diagnostic accuracy of 320-slice dynamic volume computed tomography angiography for evaluation of coronary stent patency and restenosis

Multidetector computed tomography angiography evaluation of coronaries arteries with intracycle motion correction algorithm

Purpose: Multidetector computed tomography coronary angiography (MDCT-CA) is a reliable diagnostic modality for evaluating patients with suspected CAD, with high diagnostic performance for the detection of significant coronary lesions. However, previous multicenter studies have documented lack in the MDCT-CA diagnostic performance in case of high heart rate (HR), large coronary calcification and severely elevated body mass index. Coronary arterial motion is one of the most common limitations reported, with up to 12% of coronary artery segments judged as non-evaluable. Motion artifacts are more pronounced at higher heart rates and irregular heart rhythms. Among the numerous technological solutions offered to reduce motion artifact, a novel vendor-specific motion-correction (MC) algorithm, the IntraCycle Motion Correction SnapShot Freeze (SSF), has been developed. The method utilizes information from adjacent cardiac phases within a single cardiac cycle to characterize and compensate for coronary motion. The aim of the study was to compare the global evaluability and image quality score of MDCT-CA with SSF to standard (STD) reconstructions. Methods: 60 patients with HR variability > 5 bpm during the scanning irrespective of HR before scanning or with HR before the scanning > 70 bpm were enrolled in our study (mean age 65,8±10,7 years, 41 males). MDCT-CA studies for both SSF and STD reconstructions have been presented to two blinded readers in random sequence. The number of artifacts, sub-analysis of the type of artifacts, image quality score and global evaluability of coronaries were compared in the 2 groups. Results: In 45 patients iv metoprolol (average dose 14±7.7 mg) has been administered before scanning. The average HR during the scan was 70±9 bpm. The post-processing with SSF in comparison to STD showed a significant lower number of severe artifacts (27 vs 178, p<0.0001) and slice misalignement artifacts (8 vs 143, p<0.0001), an improvement of image quality score (356 segments judged as excellent vs 129, p<0.0001) and of global coronary evaluability (97% vs 80.6%, p<0.0001). Conclusions: Use of MC algorithm SSF facilitate improvements in image quality and global coronary evaluability in patients with high and variable HR