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At least 991 records · Page 55Linked to original sources
PubMed1989

A multicenter randomized trial of ionic (ioxaglate) and nonionic (iopamidol) low-osmolality contrast agents in cardiac angiography.

A multicentered double-blind randomized study was performed comparing the electrocardiographic and hemodynamic changes induced by two new low osmolar contrast agents used for cardiac angiography. The low osmolar ionic (ioxaglate) contrast agent was compared with a low osmolar nonionic (iopamidol) contrast agent in 150 patients with angina pectoris undergoing angiography. Systolic blood pressure, left ventricular end-diastolic pressure, heart rate, and QT interval were measured just before and for 90 s following the left ventricular angiography and selective coronary angiography. Each group was also evaluated for adverse events and quality of radiographic images. Following left ventricular angiography, the systolic blood pressure dropped slightly in both groups with a greater decrease seen in the iopamidol group at 5 s (p less than 0.05). After selective right and left coronary angiography, systolic blood pressure decreased transiently and equally in both treatment groups. The left ventricular end-diastolic pressure increased after the ventriculogram in both groups (15.9 +/- 6.3 to 18.9 +/- 8.6 mmHg in the ioxaglate group and 16.1 +/- 6.7 to 20.1 +/- 7.8 mmHg in the iopamidol group), the change being significant only in the iopamidol group (p less than 0.05). Heart rate increased slightly but significantly in the ioxaglate-treated patients following left ventricular angiography (71.4 +/- 15.2 to 74.4 +/- 13.7 beats/min) (p less than 0.01). QT interval transiently increased following left ventriculography with ioxaglate (407 +/- 59.5 to 420 +/- 58.3 ms) (p less than 0.05) compared with iopamidol.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Prospective evaluation of peripheral arterial occlusive disease by 2D MR subtraction angiography.

The purpose of this study was to assess the diagnostic value of two-dimensional (2D) MR subtraction angiography of lower extremities in patients with symptomatic peripheral arterial occlusive disease with conventional angiography as the standard of reference. Twenty patients were prospectively included. 2D subtraction MR angiography (MRA) consisted of multisection gradient-recalled echo (GRE) acquisitions with the shortest TE available on our machine (4 msec), obtained in the coronal plane before and after intravenous bolus administration of gadolinium chelate. MR images were reconstructed after subtraction with a maximum-pixel-intensity-projection (MIP) algorithm. MRA was performed in all cases 1-4 days before diagnostic angiography. In a prospective blinded analysis, the number and location of significant (ie, >50%) stenoses and occlusions were evaluated for each vascular segment. Sensitivity and specificity were used to evaluate MRA data. Significant stenoses (38 of 46, 83%) and occlusions (66 of 67, 99%) seen at conventional angiography were identified with MRA. The sensitivity and specificity of MRA for determination of stenoses >50% or occlusions was 100% and 97%, respectively. The location and extent of stenoses and/or occlusions on MRA and angiograms were well correlated (kappa values, r = .73, P < .05). Contrast 2D MR subtraction angiography, by providing comparable information to that of conventional angiography, is well suited to evaluate the presence and severity of atherosclerotic lesions of the lower limbs.

Algorithms↗
PubMed1993

Delayed angiography in the investigation of intracerebral hematomas caused by small arteriovenous malformations.

We reviewed the clinical and radiological features of ten patients with small arteriovenous malformations that caused intracerebral hematomas. In six patients, angiography showed a small nidus (less than 1 cm in diameter) with a shunt at the site of the hematoma, and in four only an early-filling vein was evident. Six patients had only delayed angiography (4 weeks or more after the ictus). In three, angiography within 2 days of the ictus failed to reveal the cause of the bleed, but repeat angiography showed an early-filling vein in two, and a nidus with shunting in one. In only one patient did early angiography reveal the malformation. MRI was obtained in eight patients, and in two prominent vessels were evident in the wall of the hematoma cavity. In investigation of an unexplained intracerebral hematoma, MRI may be useful to exclude a neoplasm or cavernoma, although the latter may be not be evident in the presence of a recent hematoma. We suggest early MRI and angiography for investigation of an unexplained, nonhypertensive intracerebral bleed, with follow-up MRI and delayed angiography if the initial studies fail to reveal the cause.

Adult↗
PubMed1997

Mesenteric angiography for lower gastrointestinal hemorrhage: are there predictors for a positive study?

PURPOSE: Selective mesenteric angiography is an expensive, invasive, diagnostic, and therapeutic tool for lower gastrointestinal hemorrhage. Some institutions have required a positive nuclear medicine bleeding scan before angiography. We have attempted to determine if this is a valid screening test for mesenteric angiography. Are there any other factors to predict which patients are actively bleeding and who will benefit from angiography? METHODS: All cases of mesenteric angiography for hemorrhage performed during a 12-year period were reviewed. RESULTS: A total of 131 angiograms were performed during a 12-year period with 45 patients demonstrating active bleeding; 54 patients had a bleeding scan before angiography. A positive bleeding scan did not increase the percentage of positive angiograms. A history of prior gastrointestinal bleeding, transfusions, orthostatic hypotension, or tachycardia were not predictors for a positive angiogram. DISCUSSION: This study could not identify any single useful predictor that will increase the likelihood of obtaining a positive angiogram. Nuclear medicine scans should not be used routinely as a screening test for angiography.

Aged↗
PubMed2002

[New abdominal CT angiography protocol on a 16 detector-row CT scanner - first results].

PURPOSE: Purpose of this study was the implementation of a new abdominal CT angiography protocol on a 16 detector-row CT scanner and the comparison to selective catheter angiography. METHODS: 76 patients with various vascular disorders underwent abdominal CT angiography on a recently developed 16 detector-row CT scanner using submillimeter slice collimation (16 x 0.75 mm). Results were compared with mesenteric and/or hepatic angiography in 17 patients performed during tumor embolization. Opacification was provided using individually tailored contrast application with a test bolus setting. To evaluate the contrast injection protocol density measurements within the vessel lumen were performed. RESULTS: Diagnostic image quality was achieved in all patients with angiographic comparison (n = 17). Within the hepatic and mesenteric vasculature up to 4th generation vessels could be identified. Compared to selective angiography CT angiography provided equivalent morphologic information up to the detectable vessel generation. With the applied contrast application regimen there were no significant differences in vessel enhancement along the abdominal aorta and iliac arteries. CONCLUSION: 16 detector-row CT enables whole abdominal angiographic studies with submillimeter resolution in a single breath-hold. The improved spatial resolution enables for high quality 3D visualization. Compared to invasive angiography, 16 detector-row CT reveals equivalent morphologic information.

Abdomen↗
PubMed1997

Carbon dioxide (CO2) angiography in children.

BACKGROUND: When iodinated contrast material is contraindicated, carbon dioxide (CO2) gas can be injected intravascularly to produce high-quality digital subtraction angiograms. OBJECTIVE: CO2 angiography, although previously described in adults, has never before been reported in children. MATERIALS AND METHODS: We present three children with renal transplants who required renal angiography. Because of elevated creatinine levels, iodinated contrast was not used to search for possible renal artery stenosis. Instead, CO2 angiography was used to evaluate the renal artery anastomosis. RESULTS: In all three cases, the renal artery anastomosis was clearly visualized using CO2 angiography and showed no evidence of renal artery stenosis. CONCLUSION: Digital CO2 angiography is an effective method for pediatric renal angiography. The technique can easily be adapted for virtually any angiographic laboratory capable of digital subtraction imaging. Digital CO2 angiography also lacks the risks of a conventional iodinated contrast medium, namely nephrotoxicity, allergic reaction and volume overload.

Adolescent↗
PubMed2006

Sixty-four slice spiral CT angiography does not predict the functional relevance of coronary artery stenoses in patients with stable angina.

PURPOSE: The aim of this study was to evaluate spiral multidetector computed tomography (MDCT) angiography using 64-slice technique in the detection of functionally relevant coronary artery stenoses (CAS). METHODS: Thirty-eight patients (62+/-11 years, 28 men) with stable angina (26 with suspected and 12 with known coronary artery disease) were investigated using 64-slice MDCT angiography and gated myocardial perfusion SPECT (gated SPECT); a subgroup of 30 patients had additional invasive coronary angiography (ICA). Stenoses with luminal narrowing of >or=50% were defined as "significant" in MDCT angiography and ICA. MDCT angiography was compared with gated SPECT and the combination of gated SPECT plus ICA with respect to the detection of functionally relevant CAS. RESULTS: The sensitivity, specificity and negative and positive predictive values of MDCT angiography in detecting reversible perfusion defects on gated SPECT were 63%, 80%, 94% and 32%, respectively, in vessel-based analysis and 71%, 62%, 72% and 60%, respectively, in patient-based analysis. If only reversible perfusion defects on gated SPECT with CAS >or=50% on ICA were considered, the sensitivity, specificity and negative and positive predictive values were, respectively, 85%, 79%, 98% and 33% for vessel-based analysis and 85%, 59%, 83% and 61% for patient-based analysis. CONCLUSION: Sixty-four slice MDCT angiography failed to predict the functional relevance of CAS, but had a high negative predictive value in the exclusion of functionally relevant CAS in symptomatic patients.

Angina Pectoris↗
PubMed2001

The optimal reference population for cardiac normality in myocardial SPET in the detection of coronary artery stenoses: patients with normal coronary angiography or subjects with low likelihood of coronary artery disease?

Both subjects with a low likelihood for coronary artery disease (CAD) and patients with normal findings on coronary angiography have been used as reference populations in non-invasive stress testing, including myocardial perfusion scintigraphy. Both of these criteria of normality--low likelihood of CAD and normal coronary angiography--have been criticised, and consensus on this issue is lacking. The aim of this study was to compare two different reference populations by testing the performance of artificial neural networks designed to interpret myocardial scintigrams. The networks were trained on myocardial perfusion scintigrams from 87 patients with angiographically documented CAD and on studies from one of two different reference groups: 48 patients with no signs of CAD based on angiography or 128 healthy volunteers with a likelihood for CAD <5%. The performance of the two different networks was then tested using scintigrams from a separate test group of 68 patients. Coronary angiography was used as the gold standard in this group. The network trained on patients with no signs of CAD based on angiography showed an area under the receiver operating characteristic (ROC) curve of 93%. The ROC area for the network trained on healthy volunteers was 72%, and this difference was statistically significant (P=0.03). The results of this study using artificial neural networks suggest that normal angiography should be preferred as the reference standard in myocardial scintigraphy when a patient is examined for CAD prior to possible angiography. Whether the same is true for other indications, e.g. in prognostic evaluation, is unknown.

Adult↗
PubMed1997

[Simultaneous fluorescein and indocyanine green angiography with a confocal laser ophthalmoscope].

BACKGROUND: We report on our clinical experience with a recently developed confocal scanning laser ophthalmoscope for simultaneous fluorescein and indocyanine-green (ICG) angiography. MATERIALS AND METHODS: Following injection of fluorescein and ICG mixed in one syringe simultaneous confocal scanning laser fluorescein and ICG angiography were carried out using the Heidelberg Retina Angiograph (HRA). An argon laser (488 nm) and a diode laser beam (795 nm) from an external source were delivered via single-mode fibers. Emission was recorded between 500 and 650 nm and above 810 nm, respectively. Digital images were displayed simultaneously on a monitor during angiography. RESULTS: A total of 295 simultaneous angiograms in 268 patients with various retinal and choroidal diseases, including exudative age-related macular degeneration with occult and classic choroidal neovascularization, were obtained. High-contrast images during all phases of the angiography were obtained. Besides mild side effects in similar frequency known from individual injections, no additional toxic or allergic reactions from simultaneous injections of the two dyes were observed. CONCLUSIONS: Confocal laser scanning angiography allows for simultaneous fluorescein and ICG angiography. Compared with consecutive investigations using both dyes, simultaneous angiography requires only one injection, and offers identical digital frames. Simultaneous injection is not associated with additional side effects.

Aged↗
PubMed2003

Intraoperative angiography in the surgical treatment of cerebral arteriovenous malformations and fistulas.

BACKGROUND: The role of intraoperative angiography in the surgical treatment of cerebrovascular malformations remains controversial. The authors report on their experiences with intraoperative angiography in a series of 20 cases with cerebrovascular malformation to determine whether the use of intraoperative angiography has a favorable impact on the surgical treatment of cerebrovascular malformations. METHODS: Intraoperative angiography was performed in the surgical resection of arteriovenous malformation in 18 patients and in the surgical obliteration of arteriovenous fistula in 2 patients. The incidence of unexpected findings, such as residual nidus, demonstrated by intraoperative angiography was determined. FINDINGS: High-quality subtraction images were obtained by intraoperative angiography in every case and the findings prompted an additional procedure in 1 case that displayed an unexpected residual nidus (5.6%). There were no complications from the intraoperative angiography procedure. INTERPRETATION: Intraoperative assessment of technical results prior to wound closure offers the neurosurgeon the opportunity to resect or obliterate a vascular malformation completely, obviating a second operation.

Adolescent↗
PubMed1994

Iodixanol, a new isosmotic nonionic contrast agent compared with iohexol in cardiac angiography.

Iodixanol, a new ratio 6 nonionic iodinated contrast agent with an osmolality equal to serum, was compared with iohexol in a randomized, double-blind, parallel study. Two hundred patients undergoing elective diagnostic cardiac angiography were randomized to iodixanol (n = 101) or iohexol (n = 99). There were no differences noted between the 2 agents in the mean changes in systolic or diastolic blood pressure or heart rate during or immediately after any angiography. However, significantly more patients had a decrease in diastolic blood pressure of > 20 mm Hg during left coronary angiography with iodixanol. The only significant differences in any electrophysiologic parameter were slightly more PR prolongation during left coronary angiography with iodixanol and more ST-segment depression with iohexol during coronary angiography. Neither was clinically significant. Injection-associated discomfort occurred with both agents, but more patients experienced moderate to severe discomfort with iohexol (52%) than with iodixanol (17%) (p < 0.001). Only 1 potentially serious adverse event, ventricular fibrillation with iohexol, was considered related to contrast, and there were no differences noted between the agents. Overall, angiographic quality was equal with all angiograms being assessed as good or excellent in both groups (p = 0.885). In this low-risk population undergoing cardiac angiography, iodixanol is safe and effective without clinically important differences from iohexol. Additional studies in patients at high risk for complications should help further define the role of iodixanol in cardiac angiography.

Blood Pressure↗
PubMed1982

Noninvasive cerebrovascular evaluation: a prerequisite for angiography?

Results of cerebrovascular evaluation were reassessed in 768 patients to determine whether angiography performed in unselected patients was safe and economically efficient, and whether previous noninvasive screening was sensitive enough and effective in increasing the yield of subsequent angiography. In 543 patients undergoing angiography without previous noninvasive screening, positive results were obtained in 21 percent. Complications included hemorrhage (2.4 percent), neurologic deficit (2.2 percent), and death (0.2 percent). Of 225 patients undergoing previous screening with Doppler, ophthalmoplethysmography, and carotid phonoangiography, none with negative screening results had subsequent cerebrovascular complications. Of 82 patients having positive noninvasive test results, 53 underwent angiography with a 74 percent yield of positive results. Twenty-nine had no angiography or corrective therapeutic action. Of these, 3 percent died after a cerebrovascular accident, and 21 percent developed complete stroke (mean follow-up 3 years). Noninvasive screening reliably eliminated necessity for angiography in 64 percent of patients while increasing the angiographic yield from 21 to 74 percent. Therefore, performance of cervicoencephalic angiography is asymptomatic and unselected patients cannot be condoned any longer. Likewise, positive noninvasive screening results should not be ignored because in the absence of treatment, death (3 percent) and permanent neurologic deficit (21 percent) occur over a 3 year period.

Adult↗
PubMed1996

3D gadolinium-enhanced MR angiography of the carotid arteries.

PURPOSE: To compare gadolinium-enhanced magnetic resonance angiography (MRA) of the carotid bifurcation with 2D time-of-flight (TOF) MR angiography with regard to image quality and duration of examination. MATERIALS AND METHODS: Gadolinium contrast was administered intravenously during 3D MR imaging at 1.5 Tesla in 46 patients presenting with suspected carotid occlusive disease. 2D time-of-flight MR angiography of the carotid bifurcation had been performed in each patient prior to gadolinium-enhanced MR angiography. RESULTS: Gadolinium MRA eliminated slice misregistration and in-plane saturation artifacts that occasionally degrades 2D TOF MR angiography. Gadolinium MRA required less than 4 min to image from the aortic arch to the skull base compared to 11 min for 2D TOF with comparable signal-to-noise ratio (SNR). Postprocessing was required to eliminate overlapping venous enhancement. Both techniques had susceptibility related artifactual loss of signal at the skull base and both demonstrated a linear artifact paralleling the long axis of arteries. CONCLUSION: Gadolinium-enhanced MR angiography is a promising technique for the evaluation of patients with carotid occlusive disease because it rapidly images the carotid arteries from the aortic arch to the skull base and eliminates some of the artifacts that degrade 2D TOF MR angiography.

Adult↗
PubMed1995

Referral for coronary artery revascularization procedures after diagnostic coronary angiography: evidence for gender bias?

OBJECTIVES: We sought to determine whether there is a gender bias in the selection of patients for coronary revascularization once the severity of the underlying coronary artery disease has been established with angiography. BACKGROUND: It has been suggested that women with coronary artery disease are less likely to be referred for coronary angiography and coronary artery bypass surgery than men. Whether such a referral bias for revascularization procedures, including coronary angioplasty, is present once angiography has been performed is not clear. METHODS: We retrospectively analyzed 22,795 patients with suspected coronary artery disease who underwent coronary angiography between 1981 and 1991 and compared the numbers of women and men who underwent either coronary artery bypass surgery or coronary angioplasty within 30 days of coronary angiography. RESULTS: Angiography revealed significant (one-vessel or more) disease in 15,455 patients (52% of women, 76% of men). Despite worse symptoms, women had less extensive coronary disease than men as judged by the number of vessels diseased. Women were also more likely to have other co-morbid diseases. An equal proportion of women (54%) and men underwent revascularization procedures. After adjustment for baseline differences and age, differences in the two individual revascularization strategies were very small: More women tended to have coronary angioplasty ([absolute difference +/- 1 SD] + 3.3 +/- 0.7%, p < 0.0001), but fewer had coronary artery bypass surgery than men (-2.5 +/- 0.8%, p = 0.003). When the two revascularization strategies were considered together, there was no significant gender difference in overall adjusted use of revascularization (+ 0.8 +/- 0.9%, p = 0.41). CONCLUSIONS: Once diagnostic coronary angiography had been performed, no major differences in the overall utilization of revascularization procedures were noted for women compared with men.

Aged↗
PubMed2004

Intraoperative angiography leads to graft revision in coronary artery bypass surgery.

BACKGROUND: Graft anastomosis quality in coronary artery bypass surgery can be assessed by intraoperative angiography. The aim of the present study was to quantify the on-table revision rate initiated by intraoperative angiography. METHODS: Intraoperative angiography was carried out in 186 patients undergoing coronary artery bypass surgery, with a total of 427 grafts. The operation was performed on-pump in 34%, off-pump through a sternotomy in 49%, and as a minimally invasive direct coronary bypass grafting (MIDCAB) procedure in 17%. The angiography was performed intraoperatively while the patients were still in general anesthesia, with the possibility for on-table revision. Follow-up angiography was carried out after a mean of 346 days. RESULTS: Eighteen of 427 grafts (4.2%) were revised due to the findings at intraoperative angiography. Revision rate after on-pump surgery was 1.1%, after off-pump through a sternotomy 6.4%, and after MIDCAB 6.5%. In 6 patients the lesions were located at the distal anastomoses and in 12 patients in the conduit. All but one was successfully revised, and at 1-year follow-up all these 17 grafts were patent. CONCLUSIONS: Intraoperative angiography saves a potential number of grafts that otherwise could have been occluded. An increased implementation of intraoperative quality assessment in coronary artery bypass surgery can lead to improved outcome.

Adult↗
PubMedDate not supplied

Gadolinium-enhanced pulmonary magnetic resonance angiography in the diagnosis of acute pulmonary embolism: a prospective study on 48 patients.

OBJECTIVE: Gadolinium-enhanced pulmonary magnetic resonance angiography (MRA) can be an option in patients with a history of previous adverse reaction to iodinated contrast material and renal insufficiency. Radiation is also avoided. The aim of this study is to prospectively compare the diagnostic value of MRA with that of a diagnostic strategy, taking into account catheter angiography, computed tomography angiography (CTA), and lung scintigraphy [ventilation-perfusion (VQ)]. MATERIAL AND METHODS: Magnetic resonance angiography was done in 48 patients with clinically suspected pulmonary embolism (PE) using fast gradient echo coronal acquisition with gadolinium. Interpretation was done with native coronal images and multiplanar maximum intensity projection reconstructions. Results were compared to catheter angiography (n=15), CTA (n=34), VQ (n=45), as well as 6-12 months clinical follow-ups, according to a sequenced reference tree. RESULTS: The final diagnosis of PE was retained in 11 patients (23%). There were two false negatives and no false positive results with MRA. Computed tomography angiography resulted in no false negatives or false positives. Magnetic resonance angiography had a sensitivity of 82% and a specificity of 100%. CONCLUSION: In our study, pulmonary MRA had a sensitivity of 82% and a specificity of 100% for the diagnosis of PE, with slightly less sensitivity than CTA. In the diagnostic algorithm of PE, pulmonary MRA should be considered as an alternative to CTA when iodine contrast injection or radiation is a significant matter.

Acute Disease↗
PubMed2004

Coronary angiography transiently increases plasma pro-B-type natriuretic peptide.

AIMS: Increased plasma concentrations of B-type natriuretic peptide (BNP) and its precursor (proBNP) provide important prognostic information in patients presenting with acute coronary syndromes. Although a majority of these patients undergo early invasive assessment, the effects of coronary angiography per se on plasma BNP and proBNP concentrations are not known. We therefore sought to determine whether coronary angiography and ventriculography affect the cardiac secretion of these prognostic markers. METHODS AND RESULTS: Blood samples were collected before and two minutes after coronary angiography and ventriculography in patients with or without coronary artery disease (CAD) and normal left ventricular ejection fraction. In patients with suspected CAD and normal left ventricular ejection fraction, the plasma proBNP concentration transiently increased from 11 pmol/l (range 1-67 pmol/l) to 19 pmol/l (range 5-102 pmol/l, n=29,P<0.0001) two minutes after coronary angiography and ventriculography. The increase was similar in patients with or without CAD, although patients with stable CAD displayed higher plasma BNP and proBNP concentrations at baseline. In contrast, plasma BNP concentrations did not change after coronary angiography and ventriculography. CONCLUSION: Coronary angiography induces a transient increase in cardiac proBNP secretion. Blood sampling for plasma proBNP measurements in patient stratification and prognosis estimation should consequently be avoided immediately after coronary angiography.

Adult↗
PubMed2006

Candidate image processing for real-time volumetric CT subtraction angiography.

Since a 256-slice CT can perform real time observation of the volumetric cine images at multiple angles, volumetric CT angiography can provide much useful clinical information. Conventional CT subtraction angiography is generated by subtracting the non-enhanced CT image (mask CT image) from each contrast-enhanced CT image. Since even conventional CT subtraction angiography takes a few minutes to compute the image, volumetric CT subtraction angiography images require computation of an enormous amount of volumetric cine data (image base CT subtraction angiography: ICTSA) which means an excessively long calculating time. To reduce calculating time, we developed the raw data base CT subtraction angiography (RCTSA) that subtracts raw data instead of the reconstructed four-dimensional image sets. Image quality of the two image processing methods was evaluated in phantom and animal studies. Evaluation items were image noise, CT number uniformity, and subtracting RCTSA from ICTSA. ICTSA calculates the number of volume data; however, RCTSA uses the number of CT rotations. Moreover, since RCTSA can also be started subtraction early in the process of data acquisition, it reduced the number of calculations considerably. As there is a longer CT acquisition time, RCTSA shortens the ratio of the calculating time compared to that of ICTSA. RCTSA is useful image processing to reduce CT subtraction angiography examination time instead of ICTSA.

Angiography, Digital Subtraction↗