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PubMed2000

Pelvic and lower extremity arterial imaging: diagnostic performance of three-dimensional contrast-enhanced MR angiography.

OBJECTIVE: The diagnostic performance of a three-dimensional MR angiography-based strategy was assessed with regard to its ability to characterize the arterial vasculature from the aortic bifurcation to the lower extremity runoff vessels. A single-injection, two-station protocol in combination with a lower-extremity vascular coil was used. SUBJECTS AND METHODS: Both conventional digital subtraction angiography and three-dimensional contrast-enhanced MR angiography with a dedicated peripheral vascular coil were performed in 61 patients with suspected peripheral vascular disease. In a prospective analysis, one reviewer evaluated the digital subtraction angiographic images and a second reviewer evaluated the MR angiographic images; both were unaware of the results of the other imaging technique. Each vascular segment (29 segments per patient) was evaluated for the presence of occlusive vessel disease. The following grading system was applied: 0, normal; 1, vessel irregularity with a luminal reduction of less than 10%; 2, mild stenosis (lumen reduction, 10-49%); 3, severe stenosis (lumen reduction, 50-99%); and 4, occlusion (lumen reduction, 100%). In 11 patients surgical graft patency was assessed. RESULTS: MR angiography provided an image quality comparable with that of digital subtraction angiography. Overall sensitivity and specificity for MR angiography were 92% and 96.6%, respectively, for the detection of hemodynamically significant disease and 92.3% and 99.4%, respectively, for the detection of occlusions. CONCLUSION: Two-station contrast-enhanced three-dimensional MR angiography with a dedicated lower-extremity vascular coil proved effective enough to consider it as a noninvasive alternative to digital subtraction angiography in the assessment of the pelvic and lower extremity arterial vasculature.

Adult↗
PubMed2003

Vascular complications after living related liver transplantation: evaluation with gadolinium-enhanced three-dimensional MR angiography.

OBJECTIVE: The purpose of this study was to evaluate the efficacy of gadolinium-enhanced three-dimensional (3D) MR angiography for detection of vascular complications in patients who have undergone living related liver transplantation. MATERIALS AND METHODS: Seventy-six patients who underwent living related liver transplantation were evaluated with gadolinium-enhanced 3D MR angiography. All MR angiograms were assessed for patency of the hepatic artery and the portal vein using a four-point scale (grades I-IV). The results were correlated with conventional angiography (n = 23) and clinical follow-up with Doppler sonography (n = 53) for more than 6 months. RESULTS: Seventy-three of 76 MR angiography procedures were technically adequate. When grades III (focal narrowing [> 50%] at the anastomotic site) and IV (abrupt cutoff at the anastomotic site with nonvisualization of the right [or left] hepatic artery distal to the anastomosis) were regarded as the diagnostic criteria for hepatic artery stenosis, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MR angiography were 100%, 74%, 29%, 100%, and 77%, respectively. In the portal vein, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MR angiography were 100%, 84%, 35%, 100%, and 85%, respectively, when grades III (narrowing [> 50%] without poststenotic dilatation) and IV (narrowing [> 50%] with poststenotic dilatation) were defined as criteria for portal vein stenosis. CONCLUSION: MR angiography was sensitive but not specific in the detection of significant vascular stenosis after living related liver transplantation. However, normal MR angiography findings reliably exclude the possibility of significant stenosis.

Adolescent↗
PubMed2004

Role of a quantitative D-dimer assay in determining the need for CT angiography of acute pulmonary embolism.

OBJECTIVE: Our goal was to use the results of a quantitative D-dimer assay to determine the need for pulmonary CT angiography in patients suspected of having acute pulmonary embolism. MATERIALS AND METHODS: From July 2001 to December 2002, 755 patients underwent pulmonary CT angiography for the evaluation of acute pulmonary embolism. A rapid, fully automated quantitative D-dimer assay was obtained in more than half the patients. The electronic medical records of the patients were subsequently reviewed to analyze the negative predictive value of the D-dimer assay in the diagnostic workup of acute pulmonary embolism and to determine the outcome of the patients who had negative findings on both D-dimer assay and pulmonary CT angiography at 3-month follow-up. RESULTS: Of the 755 patients who underwent pulmonary CT angiography, 666 (88.2%) had negative findings, 73 (9.7%) had positive findings, and 16 (2.1%) were indeterminate. A total of 426 patients underwent both pulmonary CT angiography and D-dimer level evaluation, and 84 of these had negative findings (< 0.4 microg/mL) on D-dimer assay. Eighty-two of the 84 patients with negative findings on D-dimer assay had negative findings on pulmonary CT angiography; two were indeterminate and both subsequently had low-probability ventilation-perfusion studies. Among patients with positive D-dimer assays, no one with a level between 0.4 and 1.0 microg/mL had pulmonary CT angiography with findings positive for pulmonary embolism. CONCLUSION: A quantitative D-dimer assay was effective in excluding the need for pulmonary CT angiography and had high negative predictive value when the D-dimer level was less than 1.0 microg/mL.

Acute Disease↗
PubMed2004

MR angiography with sensitivity encoding (SENSE) for suspected pulmonary embolism: comparison with MDCT and ventilation-perfusion scintigraphy.

OBJECTIVE: The aim of our study was to determine the utility of time-resolved contrast-enhanced MR angiography combined with sensitivity encoding (SENSE) for patients with pulmonary embolism. SUBJECTS AND METHODS. Forty-eight consecutive patients (26 men and 22 women; age range, 27-73 years; mean age, 55 years) with suspected pulmonary embolism underwent chest radiography, contrast-enhanced MDCT, MR angiography with SENSE, ventilation-perfusion scintigraphy, and pulmonary angiography. MR angiography with SENSE was performed using IV administration of gadolinium contrast medium with a 3D turbo field-echo pulse sequence (TR/TE, 4.0/1.2; flip angle, 30 degrees ) on a 1.5-T scanner. Capabilities of diagnosing pulmonary embolism using MR angiography (data set A), contrast-enhanced MDCT (data set B), contrast-enhanced MDCT with MR angiography (data set C), ventilation-perfusion scintigraphy (data set D), and contrast-enhanced MDCT with ventilation-perfusion scintigraphy (data set E) were determined by receiver operating characteristic analysis, using the results of pulmonary angiography as the reference standard. The diagnostic capability of each data set was analyzed on a per-vascular zone and a per-patient basis with the McNemar test. RESULTS: Sensitivity and specificity of data set A were 83% and 97%, respectively, on a per-vascular zone basis and 92% and 94%, respectively, on a per-patient basis. Specificity and accuracy of data set A were significantly higher than those of data set D on a per-patient basis (p < 0.05). CONCLUSION: Time-resolved MR angiography with SENSE is effective for the diagnosis of pulmonary embolism.

Contrast Media↗
PubMed1997

Coronary angiography and angioplasty after acute myocardial infarction.

PURPOSE: To assess the data that support the use of coronary angiography and angioplasty after acute myocardial infarction, that identify the risks of these procedures, and that analyze their use and costs. DATA SOURCES: English-language articles published between 1970 and June 1995 identified through a search of the MEDLINE database. STUDY SELECTION: Studies that contained information about benefits, risks, use, and costs of coronary angiography and angioplasty after acute myocardial infarction. DATA EXTRACTION: Descriptive and analytic data from each study were collected. DATA SYNTHESIS: The outcome for patients who have complications of myocardial infarction (such as shock) is poor. Such patients usually undergo angiography, although the evidence that supports this practice is weak. Preliminary data suggest that patients who immediately have angiography and angioplasty after acute myocardial infarction have better outcomes than do patients who receive thrombolytic therapy with angioplasty only for specific indications in experienced centers. After the acute phase of myocardial infarction, patients who have noninvasive evidence of persistent or recurrent ischemia are believed to benefit from angiography. In the remaining patients, however, angiography after myocardial infarction has not been shown to be beneficial. Coronary angiography is done in 30% to 81% of patients after acute myocardial infarction in different settings and regions; for many of these patients, the benefit is questionable. Better outcomes are not always associated with more frequent use of the procedure. In the United States, catheterizations after myocardial infarction cost approximately $1 billion per year. CONCLUSIONS: Although many patients benefit from angiography and angioplasty after myocardial infarction, others probably do not. Substantial resources are at stake.

Angioplasty↗
PubMed1999

Preliminary experience using contrast-enhanced MR angiography to assess vertebral artery structure for the follow-up of suspected dissection.

BACKGROUND AND PURPOSE: Important advances have been made recently in MR angiography with the use of contrast medium injection, which has proved valuable for the imaging of vertebral arteries (VAs) obtained during short scanning times. Our purpose was to assess the feasability of contrast-enhanced fast 3D MR angiography for imaging VAs and to evaluate the long-term follow-up of VA dissections. METHODS: Sixteen consecutive patients with 18 angiographically documented VA dissections (seven occlusive dissections and 11 stenotic dissections, including two each with a pseudoaneurysm) were followed up using both contrast-enhanced 3D MR angiography and cervical T1-weighted MR imaging at a median delay of 22 months. Ten patients underwent MR imaging at the acute phase as well, and nine underwent early follow-up angiography at a median delay of 3 months. MR angiographic findings were determined by consensus, focussing on image quality, presence of residual stenosis, luminal irregularities, and occlusion. RESULTS: Of the 32 VAs, a segment of the artery was not assessable on contrast-enhanced MR angiography in each of four small VAs. A central signal void artifact of cervical arteries was seen in one patient and motion artifacts were seen in two, but images could be interpreted. A venous enhancement was detected in 10 of 16 examinations, but this did not prevent image analysis. Ten of 11 stenotic dissections returned to normal, whereas one stenotic dissection progressed to occlusion. Two pseudoaneurysms detected by initial angiography resolved spontaneously; one was revealed only by delayed MR angiography, and one was detected on an early MR angiogram and proved resolved on a late MR angiogram. Of the seven initially occluded VAs, five reopened, with a hairline residual lumen in each of three. CONCLUSION: This preliminary experience showed that contrast-enhanced MR angiography is a promising tool for imaging VAs; it allows the assessment of VA dissection changes over time. Most lesions tended to heal spontaneously, but persisting occlusion or pseudoaneurysm could be detected during the late course.

Adult↗
PubMed1999

Fairness in the coronary angiography queue.

BACKGROUND: Since waiting lists for coronary angiography are generally managed without explicit queuing criteria, patients may not receive priority on the basis of clinical acuity. The objective of this study was to examine clinical and nonclinical determinants of the length of time patients wait for coronary angiography. METHODS: In this single-centre prospective cohort study conducted in the autumn of 1997, 357 consecutive patients were followed from initial triage until a coronary angiography was performed or an adverse cardiac event occurred. The referring physicians' hospital affiliation (physicians at Sunnybrook & Women's College Health Sciences Centre, those who practice at another centre but perform angiography at Sunnybrook and those with no previous association with Sunnybrook) was used to compare processes of care. A clinical urgency rating scale was used to assign a recommended maximum waiting time (RMWT) to each patient retrospectively, but this was not used in the queuing process. RMWTs and actual waiting times for patients in the 3 referral groups were compared; the influence clinical and nonclinical variables had on the actual length of time patients waited for coronary angiography was assessed; and possible predictors of adverse events were examined. RESULTS: Of 357 patients referred to Sunnybrook, 22 (6.2%) experienced adverse events while in the queue. Among those who remained, 308 (91.9%) were in need of coronary angiography; 201 (60.0%) of those patients received one within the RMWT. The length of time to angiography was influenced by clinical characteristics similar to those specified on the urgency rating scale, leading to a moderate agreement between actual waiting times and RMWTs (kappa = 0.53). However, physician affiliation was a highly significant (p < 0.001) and independent predictor of waiting time. Whereas 45.6% of the variation in waiting time was explained by all clinical factors combined, 9.3% of the variation was explained by physician affiliation alone. INTERPRETATION: Informal queuing practices for coronary angiography do reflect clinical acuity, but they are also influenced by nonclinical factors, such as the nature of the physicians' association with the catheterization facility.

Adult↗
PubMed1999

Principles of contrast-enhanced MR angiography. Basic and clinical applications.

Contrast-enhanced MR angiography has several advantages in the clinical setting. One advantage is the shortening of T1 because the source of signal increase is resistant to signal losses caused by blood saturation, especially for in-plane flow as encountered in TOF MR angiography and PC MR angiography. This T1 reduction is clearly advantageous in obtaining images of tortuous vessels and stenotic regions. Because the contrast agent Gd-DTPA is well-tolerated and has no nephrotoxic effect, its use in patients with impaired renal function is widely accepted. It is also reported in the literature that the depiction of large aneurysms is markedly more simple with CE-MR angiography than with digital subtraction angiography because filling and subsequent washout of contrast material can be followed over a longer period of time. The main intrinsic advantage of CE-MR angiography compared with TOF and PC-MR angiography is its acquisition speed (because of ultra-short TRs) with comparable gradient performance. Also, the slice orientation can be chosen as the clinical situation dictates and needs rather than being uniformly perpendicular to blood flow, as was often necessary previously. The author considers CE-MR angiography a valuable development for vascular MR imaging. It is currently being compared with alternative methods in studies at several centers.

Arteries↗
PubMed2001

Appropriateness of the use of coronary angiography in a population of patients with ischemic heart disease.

BACKGROUND: Due to its pivotal role in the management of patients with ischemic heart disease, the use of coronary angiography has been continuously and progressively increasing over the years. However, an inappropriate rate of its utilization has been reported in 2 to 58% of cases. The aim of our study was therefore to evaluate the appropriateness of the indications for coronary angiography at our Institution. METHODS: All the patients undergoing coronary angiography at the catheterization laboratory of the Maggiore Hospital in Bologna during 1999 were evaluated. By retrospectively reviewing the data forms filled in at the time of insertion of the patient on the waiting list, the indications for coronary angiography were categorized as appropriate (class I/IIa), of uncertain value (class IIb) and inappropriate (class III), according to the guidelines of the American College of Cardiology/American Heart Association. In a blind fashion to this classification, the reports of coronary angiography were also reviewed to determine, both globally and in the different clinical subsets, the prevalence of significant coronary stenoses and of angiographically normal vessels. RESULTS: Class I/IIa indications were found in 72% of patients, as opposed to 28% in class lIb and none in class III. In the clinical subsets of stable angina, previous myocardial infarction and out-of-hospital cardiac arrest, the appropriateness was significantly higher, ranging from 74 to 100%, compared to recent myocardial infarction (63%) and unstable angina (59%) (accounting by itself for about one half of all class IIb indications). The overall prevalence of significant coronary artery disease was 87%, while in only 3% of cases did coronary angiography reveal normal vessels. CONCLUSIONS: In our population, the use of coronary angiography was highly appropriate and only seldom of uncertain value. The accurate noninvasive selection of patients which, in view of the limited access to the catheterization laboratory, we needed to perform before proceeding to coronary angiography probably played a major role in these results.

Aged↗
PubMed2001

Three-dimensional gadolinium-enhanced MR angiography of the intracranial venous system.

PURPOSE: The purpose of this study was to assess the usefulness of three-dimensional (3D) gadolinium-enhanced magnetic resonance (MR) angiography for evaluation of the intracranial venous system. MATERIALS AND METHODS: Thirty-three patients underwent 3D dynamic gadolinium-enhanced MR angiography as well as two-dimensional (2D) time-of-flight (TOF) MR venography in transverse and coronal planes and conventional catheter cerebral angiography with digital subtraction. MR venography was displayed using a maximum-intensity-projection (MIP) algorithm. The acquisition time of 3D gadolinium-enhanced MR angiography was 102 seconds, and that of 2D TOF MR venography was about 7 minutes in the transverse plane and about 9 minutes in the coronal plane. Degree of visualization of the intracranial venous system on each MR sequence was compared with that on conventional catheter cerebral angiography as a standard. RESULTS: Superficial cortical veins and the dural sinus were better visualized on 3D gadolinium-enhanced MR angiography than on 2D TOF MR venography. CONCLUSION: Three-dimensional gadolinium-enhanced MR angiography is noninvasive and very useful for imaging of the intracranial venous system. It can replace 2D TOF MR venography not only because of its short examination time but because it better demonstrates intracranial venous structures. For evaluation of the SSS, lateral sinus, sigmoid sinus and straight sinus in particular, conventional catheter angiography seems to be unnecessary.

Adult↗
PubMed2003

Preoperative assessment of stenosis of the epiaortic vessels: can colour-Doppler ultrasound really supplant angiography?

PURPOSE: To evaluate the diagnostic role of digital angiography compared with colour-Doppler US in the study of epiaortic vessel stenoses and the degree of morbidity associated with angiography. MATERIALS AND METHODS: Out of 2,000 angiographic examinations of the epiaortic vessels performed for the concurrent presence of clinical findings of cerebrovascular insufficiency and colour-Doppler US findings of carotid-vertebral stenosis, a randomized sample of 200 patients was evaluated. The retrospective review of medical records provided the surgical data of the stenosis which were subsequently compared with the angiography and colour-Doppler US findings, and with the clinical and laboratory data to identify the possible complications of angiography. RESULTS: Diagnostic agreement was 75%. Colour-Doppler US underestimated stenosis in 16.5% and overestimated stenosis in 8% of cases. In 18% of cases there was a diagnostic gain of angiography (vascular lesions associated with main lesion), which also provided clinically important incidental findings (intracranial aneurysms, meningiomas) in 6.5% of patients. No relevant complications resulting from the angiographic procedure were recorded. CONCLUSIONS: Angiography allowed a more accurate evaluation of the degree of stenosis compared with colour-Doppler ultrasound. Moreover, it allowed diagnosis of important associated conditions that may affect therapeutic planning. In our series, we recorded no important complications related to angiography. Therefore, angiography remains the standard of reference in the preoperative evaluation of patients with clinically diagnosed cerebral ischaemia. Though fairly reliable as a first-line investigation, Colour-Doppler US is not sufficiently exhaustive as a pre-operative evaluation tool.

Angiography↗
PubMed2004

[Comparison of the findings of multislice CT and angiography after stenting for supraaortic arteries].

We compared the findings of multislice computed tomography (MSCT) with angiography after stenting for supraaortic arteries. Twelve cases that underwent both MSCT and angiography were evaluated. In 4 cases, stenotic findings were shown by neither MSCT nor angiography. Lumen diameters measured by MSCT tended to be shorter than those measured by angiography. In-stent stenosis evaluated by MSCT was found in 6 cases, and all of them revealed low density areas in the inner stent lumen. In 4 of them, intimal hyperplasia was indicated by angiography, but in 2 of them, unexpectedly, no stenotic findings were found by angiography. In one case, using MSCT the part two stents partially lying over one another revealed severe artifact in the inner stent lumen, but no stenosis was found by angiography. In 2 cases, unevenly spread extra-stent space was found, but that was not revealed by angiography. We conclude that MSCT is useful to evaluate lumen diameter, in-stent intimal hyperplasia, in-stent thrombus, and extra-stent space.

Angiography↗
PubMedDate not supplied

Renal dysfunction after angiography; a risk factor analysis in patients with peripheral vascular disease.

Angiography is required for a detailed anatomical investigation before reconstructive surgery or percutaneous transluminal angioplasty can be performed. Although angiography is a safe procedure, it is associated with renal dysfunction, usually transient, in about 10% of the cases. This study concentrates on the evaluation of renal dysfunction induced by "conventional" (i.e. film-screen) Seldinger angiography and a consecutive series of 396 angiographic procedures have been evaluated. Induced Renal Dysfunction was defined as an increase of more than 10% in the serum creatinine after angiography. To identify "risk factors" for Induced Renal Dysfunction we have studied whether clinical and angiographical variables were associated with the occurrence of Induced Renal Dysfunction. These variables included: age, hypertension, the use of antihypertensive drugs, diabetes mellitus, technique of angiography, site of contrast injection and type and quantity of contrast medium. Induced Renal Dysfunction was found in 21 cases (5.7%) and appeared to be associated with age above 70, hypertension, administration of more than 150 ml contrast medium and the presence of renal disease prior to angiography. More than 95% of the 21 patients with dysfunction had two or more of these "risk factors". The presence of diabetes was not clearly associated with Induced Renal Dysfunction and haemodialyses was not required in any of the patients. The incidence of Induced Renal Dysfunction after angiography was 5.7% which is low but not negligible. However, renal dysfunction was always transient and never severe. Furthermore, the identification of "risk factors" allows the prompt identification of patients at risk before angiography, which may help to reduce the incidence of Induced Renal Dysfunction.

Acute Kidney Injury↗
PubMed1988

[Recurrence of AVM after disappearing on postoperative angiography--report of two cases].

We reported two cases of recurrent arteriovenous malformation (AVM), which had been operated on before and these AVMs disappeared on postoperative angiography. The first case was a 13-year-old boy who had suffered from intracerebral hematoma at the age of nine years. The first angiography showed AVM located in the left central region, fed by peripheral branches of the anterior and middle cerebral arteries. Sixteen days after the onset, removal of the AVM was carried out. Postoperative course was uneventful and angiography showed that the AVM had disappeared. However, 4 years later, follow-up digital subtraction angiography showed that the AVM had reappeared in the operated region. Extirpation of the recurrent AVM was repeated. The second case was a 28-year-old woman who had presented intracerebral hematoma at the age of 23 years. Angiography revealed AVM located in the right posterotemporal region, fed by a temporal branch of the middle cerebral artery. Removal of the AVM was carried out one month after the onset. Postoperative neurological status was good and angiography showed no residual AVM. Five years later, enhanced CT scan demonstrated a linear enhanced area in the operated region. This led us to suspect recurrence of the AVM. Conventional angiography presented reappearance of the AVM, and reoperation was performed. Reported cases of AVM, which recurred after disappearing on postoperative angiography, were very rare. Small abnormal vascular channels located in the surrounding area of the main nidus may be left after the initial operation, and they may have grown to nidus some years later.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Rapid noninvasive diagnosis and surgical repair of acute ascending aortic dissection. Improved survival with less angiography.

Angiography has been considered the gold standard for the diagnosis of acute dissection of the ascending aorta, but it may increase mortality by imposing an unnecessary delay before surgical repair. In addition, coronary angiography has often been considered essential as well. From 1988 to 1993, 37 patients (median age 61 years, 30 men and 7 women) had acute dissection of the ascending aorta. All of the initial 15 patients (group I) had angiography, even through the diagnosis of aortic dissection had already been made noninvasively in 14; six (40%) of 15 died, three of aortic rupture and none of complications of coronary artery disease. Among the next 22 patients (group II), 21 had a noninvasive diagnosis of acute dissection of the ascending aorta (eight by echocardiography; 13 by computed tomography), and 19 (86%) were operated on without angiography; two died (9%, p = 0.03 versus group I) and neither death was due to aortic rupture or coronary artery disease. Overall, either root or selective coronary angiography was attempted in 18 of 37 patients, but it documented coronary artery disease in only two patients (11%). Coronary artery disease was found in four other patents at autopsy; three of them, including two that died of aortic rupture, had angiography that failed to reveal the coronary artery disease. Noninvasive diagnosis of acute dissection of the ascending aorta is reliable and avoids the risks and delays inherent in invasive angiography. Rapid noninvasive diagnosis of aortic dissection and avoidance of routine angiography appear to improve survival by expediting surgical intervention and thus decreasing the risk of aortic rupture.

Acute Disease↗
PubMed1993

Racial variations in the rates of carotid angiography and endarterectomy in patients with stroke and transient ischemic attack.

BACKGROUND: Carotid endarterectomy is emerging as the treatment of choice for patients with symptomatic carotid artery stenosis at low operative risk. We sought to determine if racial variations in the rate of carotid angiography and endarterectomy exist in the Veteran Affairs health care system among patients who are insulated from the cost of their care. METHODS: From a national database of all hospitalizations at Veterans Affairs medical centers, we identified a cohort of patients with diagnoses of stroke or transient ischemic attack who were likely to be candidates for carotid angiography and endarterectomy. We used logistic regression to determine if the patient's race was associated with receiving carotid angiography and endarterectomy, after adjusting for patient's age, degree of eligibility for Veterans Affairs care, socioeconomic status, comorbidities associated with hospital admission, and geographic region of the hospital. RESULTS: Of the 35 922 veterans in the cohort, 3535 (9.8%) underwent angiography during the study period and 1249 (3.5%) had carotid endarterectomy. Blacks constituted 18.2% of the patients with a history of stroke or transient ischemic attack, 9.8% of the patients having angiography, but only 4.2% of the patients undergoing carotid endarterectomy. Whites constituted 77.1% of the patients with a history of stroke or transient ischemic attack, 86.1% of the patients receiving angiography, and 93.0% of those having carotid endarterectomies. After adjusting for confounding variables, black patients continued to have a significantly lower likelihood than white patients of undergoing angiography (risk ratio = 0.47; 95% confidence interval = 0.42, 0.53) and subsequent endarterectomy (risk ratio = 0.28; 95% confidence interval = 0.20, 0.38). CONCLUSIONS: Socioeconomic status and access to care within a large managed health care system do not fully explain racial differences in the rate of carotid angiography and endarterectomy. Either referral bias for evaluation for carotid endarterectomy or racial differences in the extent and location of cerebrovascular disease are more important explanations for the observed racial variations.

Aged↗
PubMed1993

Racial differences in the use of revascularization procedures after coronary angiography.

OBJECTIVE: To assess whether rates of coronary revascularization procedures differ between blacks and whites after coronary angiography is performed and to assess the relationship of these rates to hospital characteristics. DESIGN: A retrospective cohort study using 1987 and 1988 data on hospital claims and characteristics from the Health Care Financing Administration. SETTING: One thousand four hundred twenty-nine acute care hospitals that provide coronary angiography in the United States. PATIENTS: A national sample of 27,485 Medicare Part A enrollees, aged 65 to 74 years, who underwent inpatient angiography for coronary heart disease in 1987. MAIN OUTCOME MEASURE: The adjusted odds of revascularization with either coronary angioplasty or bypass graft surgery within 90 days of angiography for whites relative to blacks, controlling for age, sex, region, Medicaid eligibility, principal diagnosis, comorbid diagnoses, and hospital characteristics of ownership, teaching status, urban/suburban or rural location, and availability of revascularization procedures. RESULTS: White men and women were significantly more likely than black men and women, respectively, to receive a revascularization procedure after coronary angiography (57% and 50% vs 40% and 34%, both P < .001). The adjusted odds of receiving a revascularization procedure after coronary angiography were 78% higher for whites than blacks (95% confidence interval for odds ratio, 1.56 to 2.03). Statistically significant racial differences in the adjusted odds of receiving a revascularization procedure were present in all types of hospitals except rural hospitals, and these differences did not vary significantly by any of the four hospital characteristics (all P > .20 for interaction terms). CONCLUSIONS: Among Medicare enrollees, whites are more likely than blacks to receive revascularization procedures after coronary angiography. Racial differences of similar magnitude occur in all types of hospitals. These differences may reflect overuse in whites or underuse in blacks, but they are unlikely to reflect access to cardiologists or hospitals that perform revascularization procedures. Potential explanations include unmeasured clinical or socioeconomic factors, differing patient preferences, and racial bias at the hospitals performing angiography.

Black or African American↗
PubMed1996

TAT, F1 + 2, and D-dimer levels in patients after coronary angiography with nonionic or ionic contrast media or after cardiac catheterization.

The prothrombotic effects of nonionic contrast media (NICM) have been evaluated in both biological and clinical studies. The question of whether there is a higher risk of thromboembolism during angiography with NICM than with ionic contrast media (ICM) has not yet been answered, nor has the precise role of the angiographic procedure per se in such complications been determined. The present study was performed to compare in vivo the potential prothrombotic effects during cardiac angiography of an NICM with those of an ICM, to estimate the effects of the procedure per se, and to assess how long these effects might be maintained. We measured blood levels of three markers of activation of blood coagulation: thrombin-antithrombin III (TAT) complexes, prothrombin fragment 1 + 2 (F1 + 2), and the split product of fibrin, D-dimer, before and after coronary angiography in three groups of patients. In group 1, 14 patients underwent coronary angiography with the NICM iopamidol 370. In group 2, 10 patients underwent coronary angiography with the ICM ioxaglate. In group 3, 10 patients were evaluated immediately after cardiac catheterization, before the injection of contrast material, as controls. No statistically significant differences between the three groups were found in TAT, F1 + 2, or D-dimer levels at different times before and after coronary angiography. There was a trend toward a transient increase in TAT levels after coronary angiography with iopamidol, which at first suggested a possible brief activation of hemostasis with this NICM, but a similar trend was also seen in the control group. We hypothesize that not only the type of contrast material, but also the angiographic procedure per se and patient-related factors all play roles in determining a prothrombotic state during coronary angiography.

Aged↗