Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Angiography”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,045 records · Page 58Linked to original sources
PubMed1997

Indocyanine green angiography and transmission defects.

PURPOSE: Several reports have suggested that indocyanine green angiography is of value in identifying late hyperfluorescent subretinal tissue presumed to be choroidal neovascularization. However, fluorescein angiography may also reveal late hyperfluorescence from transmission defects caused by atrophy of the retinal pigment epithelium. We studied the indocyanine green angiographic characteristics of transmission defects to determine if indocyanine green angiography can differentiate choroidal neovascularization from the retinal pigment epithelium atrophy. METHODS: Indocyanine green angiograms of 23 eyes with geographic atrophy secondary to age-related macular degeneration and without any signs or history of choroidal neovascularization were reviewed. RESULTS: Indocyanine green angiography demonstrated late hypofluorescence of various degrees in the area of geographic atrophy. There was no evidence of late hyperfluorescence. CONCLUSION: Late hyperfluorescence evident on fluorescein angiography which can be caused by choroidal neovascularization or transmission defects is not seen in retinal pigment epithelium atrophy imaged by indocyanine green angiography. According to these results indocyanine green angiography is useful to differentiate occult choroidal neovascularization from areas of retinal pigment epithelium atrophy.

Aged↗
PubMed2002

Use of magnetic resonance angiography to select candidates with recently symptomatic carotid stenosis for surgery: systematic review.

OBJECTIVE: To determine if sufficient evidence exists to support the use of magnetic resonance angiography as a means of selecting patients with recently symptomatic high grade carotid stenosis for surgery. DESIGN: Systematic review of published research on the diagnostic performance of magnetic resonance angiography, 1990-9. MAIN OUTCOME MEASURES: Performance characteristics of diagnostic test. RESULTS: 126 potentially relevant articles were identified, but many articles failed to examine the performance of magnetic resonance angiography as a diagnostic test at the surgical decision thresholds used in major clinical trials on endarterectomy. 26 articles were included in a meta-analysis that showed a maximal joint sensitivity and specificity of 99% (95% confidence interval 98% to 100%) for identifying 70-99% stenosis and 90% (81% to 99%) for identifying 50-99% stenosis. Only four articles evaluated contrast enhanced magnetic resonance angiography. CONCLUSIONS: Magnetic resonance angiography is accurate for selecting patients for carotid endarterectomy at the surgical decision thresholds established in the major endarterectomy trials, but the evidence is not very robust because of the heterogeneity of the studies included. Research is needed to determine the diagnostic performance of the most recent developments in magnetic resonance angiography, including contrast enhanced techniques, as well as to assess the impact of magnetic resonance angiography on surgical decision making and outcomes.

Carotid Stenosis↗
PubMed1997

Importance of right ventricular outflow tract angiography in distinguishing critical pulmonary stenosis from pulmonary atresia.

OBJECTIVE: To investigate the spectrum of pulmonary atresia and critical pulmonary stenosis using right ventricular outflow tract angiography and explore its implications for catheter interventional treatment. DESIGN: Prospective clinical study. SETTING: Two paediatric cardiology centres. SUBJECTS: 11 neonates or infants (aged 1 day to 8 months; weighing 2.3 to 7.8 kg) with pulmonary atresia or where the differentiation of pulmonary atresia from critical pulmonary stenosis was unclear on either echocardiography or angiography. METHODS: Right ventricular outflow tract angiography was performed on all patients to distinguish pulmonary atresia from critical pulmonary stenosis before opening the right ventricular outflow tract. RESULTS: Right ventricular outflow tract angiography showed that three of seven patients diagnosed as pulmonary atresia by echocardiography had pin hole jets across the pulmonary valve; another had a probe patent valve that appeared imperforate on both echocardiography and right ventricular outflow tract angiography. Three of the four patients diagnosed by echocardiography as critical pulmonary stenosis were found on right ventricular outflow tract angiography to have pulmonary atresia. The remaining patient had such a tiny orifice that a second orifice had to be created with a radiofrequency catheter. The right ventricular outflow tract was opened successfully in 10 of the 11 patients, six of whom required application of radiofrequency energy. The right ventricular to aortic systolic pressure ratio fell from 1.4 (0.9 to 1.9) to 0.6 (0.2 to 1.1) (P < 0.05). All 11 patients were alive and well with transcutaneous oxygen saturations ranging from 84% to 95% at a median follow up duration of nine months. CONCLUSIONS: Critical pulmonary stenosis and pulmonary atresia cannot always be accurately distinguished by echocardiography. Right ventricular outflow tract angiography helps to distinguish the two groups. In most cases the right ventricular outflow tract can be opened without mortality and with short to medium term survival.

Catheter Ablation↗
PubMed1990

Complications of cerebral angiography for patients with mild carotid territory ischaemia being considered for carotid endarterectomy.

It is essential to image the carotid bifurcation adequately in patients with symptomatic carotid territory ischaemia if they are being considered for carotid endarterectomy. Optimal resolution is achieved by selective intraarterial contrast angiography which is an invasive procedure carrying some risk. The overall risk-benefit of carotid endarterectomy is currently being investigated in several large randomised trials in Europe and North America. Because cerebral angiography is a prerequisite for carotid endarterectomy, the risks of cerebral angiography will need to be added to those of surgery when considering whether carotid endarterectomy is effective in the management of these patients. This study evaluated prospectively 382 patients with symptomatically mild carotid ischaemia who had cerebral angiography to visualise a potentially resectable lesion at the carotid bifurcation. Complications followed 14 cerebral angiograms in 13 patients (3.4%); two complications were local (0.5%), two systemic (0.5%) and 10 were neurological (2.6%). The neurological complications were transient (TIA 1, generalised seizure 1) in two patients (0.5%), reversible (stroke) in three (0.8%) and permanent (stroke) in five patients (1.3%). There were no deaths. The significant risk factors for post angiographic stroke were (1) stroke before angiography compared with transient ischaemic attacks of the eye or brain and (2) the presence of greater than or equal to 50% diameter stenosis of the symptomatic internal carotid artery; unfortunately it may be the latter patients who are most at risk of stroke as part of the natural history of their disease and therefore most in need of prophylactic carotid endarterectomy (which requires cerebral angiography). The absolute risk of post-angiographic stroke of patients for cerebral angiography using clinical evaluation and Duplex carotid ultrasound screening.

Adolescent↗
PubMed2004

Non-clinical factors influencing the selection of patients with acute coronary syndromes for angiography.

OBJECTIVE: To analyse clinical and non-clinical factors determining the selection for coronary angiography in patients with acute coronary syndromes (ACS). DESIGN: Single centre, prospective cohort study. PARTICIPANTS: Eighty consecutive patients admitted with a diagnosis of ACS during the period 21 May 2001 to 4 July 2001. SETTING: Coronary care unit of a tertiary referral centre, the Manchester Royal Infirmary. DATA COLLECTION: Information concerning baseline patient characteristics, clinical presentation, and the selection for angiography was collected from the patient notes. DATA COLLECTION: Windows SPSS version 9.0 using cross tabulations with chi(2) estimation and binomial logistic regression analysis. MAIN OUTCOME MEASURE: Selection for angiography in ACS. RESULTS: Cross tabulations with chi(2) analysis and logistic regression analysis identified significant non-clinical factors predicting the use of angiography. Although clinical factors such as recurrent ischaemia (odds ratio 5.11) influenced the decision to undergo coronary angiography, non-clinical factors such as young age (odds ratio 6.88 for <65 years old), gender (odds ratio 3.81 for males), admission on a weekday (odds ratio 0.2488 for admission on the weekend), and consultant in charge (odds ratio 0.111 for consultant "2") independently predicted the use of angiography in ACS. CONCLUSION: The selection of patients for angiography in ACS is not based purely on clinical criteria. Awareness of the apparent sources of bias among clinical decision makers may improve management of these patients.

Acute Disease↗
PubMedDate not supplied

MR angiography after renal revascularization: spectrum of expected anatomic results and postintervention complications.

The use of magnetic resonance (MR) angiography in screening for renal artery stenosis has been extensively evaluated. However, the MR angiographic findings after renal artery revascularization are not as well characterized. The renal artery and parenchyma can be evaluated after revascularization with a comprehensive MR imaging protocol that includes T1- and T2-weighted spin-echo sequences, three-dimensional (3D) gadolinium-enhanced MR angiography, and 3D phase-contrast MR angiography. Because surgical techniques for revascularization vary, knowledge of the surgical procedure is necessary to ensure inclusion of the pertinent anatomy at 3D gadolinium-enhanced MR angiography and to define appropriate 3D phase-contrast MR angiography volumes. The 3D gadolinium-enhanced MR angiography volume can be manipulated to view relevant vascular anatomy at the optimal obliquity and section thickness. This protocol allows robust, noninvasive evaluation of the expected arterial anatomy after revascularization, including renal artery endarterectomy, aortorenal bypass grafts, and extraanatomic reconstructions. In cases of suspected postrevascularization complications, gadolinium-enhanced MR angiography is useful because of its lack of nephrotoxicity and radiation exposure. Immediate complications of renal revascularization include renal artery thrombosis, renal infarction, and perinephric hemorrhage. Long-term complications include aneurysms of bypass grafts and recurrent stenosis of the renal artery.

Adult↗
PubMed2002

Helical CT with CT angiography in assessing periampullary neoplasms: identification of vascular invasion.

PURPOSE: To determine the accuracy of helical computed tomography (CT) with CT angiography in identifying vascular invasion by periampullary neoplasms and to assess the added value of CT angiography. MATERIALS AND METHODS: Sixty-nine patients suspected of having periampullary neoplasms were examined. Images from dual phase helical CT with CT angiography were compared with surgical findings in 36 patients. Arterial and venous invasion were assessed separately. Accuracy, positive predictive value (PPV), and negative predictive value (NPV) were determined for CT alone and for CT supplemented with CT angiography. RESULTS: The accuracy, PPV, and NPV of helical CT with CT angiography in identifying venous invasion was 92% (33 of 36 patients), 86% (12 of 14 patients), and 95% (21 of 22 patients), respectively. When transverse CT images alone were analyzed, accuracy decreased to 69% (25 of 36 patients) (P =.005); PPV and NPV were 63% (five of eight patients) and 71% (20 of 28 patients), respectively. When identifying arterial invasion, the accuracy of CT with CT angiography and of CT alone was 86% (31 of 36 patients). PPV and NPV also were identical at 71% (five of seven patients) and 90% (26 of 29 patients), respectively. CONCLUSION: CT angiography significantly increases the ability to identify venous invasion when compared with CT alone but does not improve detection of arterial invasion.

Adult↗
PubMed2004

Infrarenal aortic and lower-extremity arterial disease: diagnostic performance of multi-detector row CT angiography.

PURPOSE: To compare multi-detector row spiral computed tomographic (CT) angiography with digital subtraction angiography (DSA) in evaluation of the infrarenal aorta and lower-extremity arterial system. MATERIALS AND METHODS: Fifty patients with peripheral arterial occlusive disease were evaluated with multi-detector row CT angiography and DSA. Arteries depicted at CT angiography and DSA were graded separately for degree of stenosis as 23 anatomic segments (infrarenal aorta, right and left common iliac artery, internal iliac artery, external iliac artery, common femoral artery, superficial femoral artery, deep femoral artery, popliteal artery, anterior tibial artery, tibioperoneal trunk, posterior tibial artery, and peroneal artery). Grades included the following: 1, normal patency; 2, moderate (< or =50%) stenosis; 3, focal severe (>50%) stenosis; 4, multiple severe stenoses; and 5, occlusion. Three readers independently interpreted the images, and statistical analysis was performed. The results of image interpretation were evaluated for strength of agreement by using Cohen kappa statistics. On the basis of consensus readings, sensitivity, specificity, and accuracy for detection of stenotic lesions were calculated, with findings at DSA used as the reference standard. RESULTS: Substantial to almost perfect interobserver agreement was achieved in all cases. At DSA, 349 diseased segments were found among the 1,137 segments evaluated. Sensitivity, specificity, and accuracy, based on a consensus reading of multi-detector row CT angiograms, were 96%, 93%, and 94%, respectively. A statistically significant difference (P <.05) between DSA and multi-detector row CT angiography was present only in arteries graded 1 or 2. Interobserver agreement was almost perfect among the three readers for treatment recommendations based on findings at CT angiography and DSA. CONCLUSION: Multi-detector row CT angiography appears consistent and accurate in the assessment of patients with peripheral arterial occlusive disease.

Adult↗
PubMed2006

Peripheral arterial disease: clinical and cost comparisons between duplex US and contrast-enhanced MR angiography--a multicenter randomized trial.

PURPOSE: To prospectively determine the clinical and economic consequences of replacing duplex ultrasonography (US) with contrast material-enhanced magnetic resonance (MR) angiography for the initial imaging work-up of patients with peripheral arterial disease (PAD). MATERIALS AND METHODS: This randomized multicenter study was approved by the institutional review board of each hospital, and all patients signed written informed consent prior to randomization. Patients with PAD who needed to undergo imaging work-up and who had an ankle-brachial pressure index (ABPI) of less than 0.90 were recruited by vascular surgeons between January 2002 and September 2003. Patients were randomly assigned to undergo contrast-enhanced MR angiography or duplex US. The primary outcome measure was cost. Secondary outcome measures included therapeutic confidence, changes in disease severity, and changes in quality of life (QOL) assessed during 6 months of follow-up. Indicators for disease severity were based on the Rutherford classification, treadmill walking distance, ABPI at rest, and ABPI after exercise. QOL was assessed with the Rating Scale, Short Form 36, EuroQol-5D, and VascuQol questionnaires. The cost of (additional) imaging procedures, therapeutic interventions, and outpatient visits were calculated from a hospital perspective (ie, all costs incurred inside the hospital were estimated, including physician costs). Data were evaluated by using the Student t test and a multivariable linear regression analysis. RESULTS: At 6 months, 352 patients (239 [68%] men, 113 [32%] women; mean age, 65 years) were analyzed. The use of contrast-enhanced MR angiography versus duplex US reduced the number of additional vascular imaging procedures by 42%; contrast-enhanced MR angiography was also associated with higher therapeutic confidence. Diagnostic costs for contrast-enhanced MR angiography were 167 euros (186 dollars) higher than those for duplex US (P < .001). No statistically significant differences were found for total cost, changes in disease severity, or changes in QOL between patients examined with duplex US and those examined with contrast-enhanced MR angiography (P > .05). CONCLUSION: Replacing duplex US with contrast-enhanced MR angiography for the initial imaging work-up of patients with PAD reduces the need for additional imaging, although diagnostic costs are higher.

Aged↗
PubMed1992

Cerebral MR angiography with multiple overlapping thin slab acquisition. Part II. Early clinical experience.

In a prospective, multicenter study of 164 patients, cerebral magnetic resonance (MR) angiography with multiple overlapping thin slab acquisition was evaluated for image quality and diagnostic accuracy. Of the 164 patients, 87 (53%) underwent either correlative cut-film angiography or surgery. The overall image quality was excellent in 90% of patient studies. Eighteen of 19 aneurysms were detected with MR angiography. The parent artery, the anatomy of the neck and dome, and the size were correctly shown in 17 of the 19 aneurysms. All 19 vascular malformations were seen with MR angiography. Venous malformations and single pedicle arteriovenous malformations were completely defined with MR angiography, while complete definition of complex arteriovenous malformations was frequently difficult. In cerebral tumors, the arteries and veins important in surgical planning were accurately shown in all cases. In ischemic cerebrovascular disease, MR angiography depicted all stenoses and occlusions of first- and second-order cerebral arteries. The inability to depict intraluminal filling defects in any but the large central arteries limited the ability of MR angiography to enable the specific diagnosis of embolic stroke.

Brain Ischemia↗
PubMed1992

Moyamoya disease: diagnosis with three-dimensional time-of-flight MR angiography.

Twelve patients with moyamoya disease were studied with three-dimensional time-of-flight magnetic resonance (MR) angiography, and the findings were compared with results obtained with conventional arteriography. Of a total of 24 supraclinoid internal carotid arteries studied, 21 arteries (88%) were accurately evaluated with MR angiography and in three arteries the extent of occlusive disease was overestimated. Of a total of 72 large branch basal cerebral vessels, including the bilateral anterior, middle, and posterior cerebral arteries, 61 arteries (85%) were accurately evaluated with MR angiography and in 11 arteries the extent of occlusive disease was overestimated. While conventional arteriography showed basal cerebral moyamoya vessels in all 24 hemispheres, MR angiography showed moyamoya vessels in 20 of these. Of a total of 28 large leptomeningeal and transdural collateral vessels, 18 were identified with MR angiography. In the one surgical collateral vessel evaluated, MR angiography successfully showed its patency. MR angiography may have value in following disease progression and, perhaps, in evaluation of surgical bypass patency.

Adolescent↗
PubMed1996

Spiral CT angiography for suspected pulmonary embolism: a cost-effectiveness analysis.

PURPOSE: To investigate the cost-effectiveness of diagnostic strategies involving spiral computed tomographic (CT) or conventional pulmonary angiography in the diagnosis of suspected pulmonary embolism. MATERIALS AND METHODS: A model was created for analyzing cost-effectiveness on the basis of available literature data. Diagnostic algorithms consisting of combinations of perfusion and ventilation scintigraphy, ultrasound, D-dimer assay, conventional angiography, and spiral CT angiography were compared. Preference for strategies was determined on the basis of the mortality and cost per life saved. RESULTS: For all realistic values of the pretest probability of pulmonary embolism and coexisting deep vein thrombosis and of the specificity of spiral CT angiography, all of the best strategies included spiral CT angiography. With an assumed sensitivity for spiral CT angiography of less than 85%, a conventional angiographic strategy yielded a lower mortality but did not yield superior cost-effectiveness. CONCLUSION: The use of spiral CT angiography is likely to reduce the mortality and improve cost-effectiveness in the diagnostic work-up of suspected pulmonary embolism.

Algorithms↗
PubMed1996

Pulmonary embolism: validation of spiral CT angiography in 149 patients.

PURPOSE: To assess the reliability of spiral computed tomographic (CT) angiography of the pulmonary arteries in the diagnosis of pulmonary embolism (PE). MATERIALS AND METHODS: One hundred forty-nine patients clinically suspected of having PE underwent spiral CT angiography and ventilation-perfusion (V-P) scintigraphy. Pulmonary angiography was also performed when the results of the V-P scan were indeterminate. Imaging results of spiral CT angiography were compared and validated against a normal perfusion scan in 40 patients, a high-probability scintigram in 53 patients, and a pulmonary angiogram in 56 patients. RESULTS: Spiral CT angiograms were of satisfactory diagnostic quality in all 149 patients. The sensitivity of spiral CT angiography for the detection of PE was 94% (64 of 68 patients) (observer 1) and 82% (56 of 68 patients) (observer 2), and the specificity was 96% (78 of 81 patients) (observer 2). Good interobserver agreement was obtained for spiral CT angiographic results (kappa = .774). Spiral CT angiography proved to be effective in the detection of PE in pulmonary arteries up to the segmental level but not in the smaller subsegmental branches. Isolated subsegmental PE accounted for three false-negative spiral CT angiographic results for both observers. CONCLUSION: Spiral CT angiography is an accurate method for the detection and exclusion of PE, with the exception of isolated subsegmental PE.

Aged↗
PubMed2000

MR angiography of the intracranial venous system.

PURPOSE: To compare the effectiveness of different imaging planes at time-of-flight (TOF) magnetic resonance (MR) angiography and phase-contrast MR angiography in the visualization of the normal intracranial venous system. MATERIALS AND METHODS: In 12 healthy volunteers, two-dimensional (2D) TOF MR angiography and three-dimensional (3D) phase-contrast MR angiography were performed in transverse, sagittal, and coronal planes. All data were displayed as maximum intensity projection (MIP) images. Four neuroradiologists assessed the visibility of 28 intracranial venous structures on the MIP images. Statistical analysis was performed by using the Friedman two-way analysis of variance and the Cochran Q test. RESULTS: Visualization of the normal intracranial venous system was better with 3D phase-contrast and coronal 2D TOF MR angiography than with transverse or sagittal 2D TOF MR angiography (P < .05, Friedman test) for each observer and the group of observers. Differences were found between each of the 2D TOF and 3D phase-contrast MR angiographic sequences in the visualization of individual venous structures (Cochran Q test). The kappa values ranged from 0.36 to 0.71, which indicated a moderate to good agreement between observers. CONCLUSION: The normal intracranial venous system is adequately visualized with 3D phase-contrast and coronal 2D TOF MR angiography.

Adult↗
PubMed2001

Spinal vascular malformations: MR angiography after treatment.

PURPOSE: To evaluate the role of magnetic resonance (MR) angiography in the assessment of spinal vascular malformation therapy. MATERIALS AND METHODS: Thirty-four patients with spinal vascular malformations (30 dural arteriovenous fistulas, two perimedullary arteriovenous fistulas, and two intramedullary arteriovenous malformations) underwent MR angiography and MR imaging before and after endovascular or surgical treatment. RESULTS: MR angiography showed residual flow in perimedullary vessels in seven patients with dural fistula after embolization with liquid adhesive. In all seven, treatment failure was confirmed with arteriography. Long-lasting disappearance of flow in perimedullary vessels was demonstrated at MR angiography in 22 patients with dural fistula. MR imaging demonstrated normalization of spinal cord volume in 16 of 22 patients and signal intensity on T2-weighted images in three patients. Disappearance of cord enhancement was observed in five of 21 patients and of perimedullary enhanced vessels in six of 13 patients. In one additional patient with dural fistula treated with embolization, early posttreatment MR angiography showed disappearance of flow in perimedullary vessels, which reappeared at follow-up and was consistent with reopening of a small residual fistula. Posttreatment MR angiography demonstrated transient reduction of flow in the nidus in two patients with intramedullary malformations treated with embolization. Permanent disappearance of flow in the perimedullary vessel was seen after endovascular treatment in two patients with perimedullary fistula. CONCLUSION: MR angiography is more sensitive than MR imaging in depicting residual or recurrent flow in peri- or intramedullary vessels, which indicates patency of the vascular malformation.

Adolescent↗
PubMed1983

Prediction of cardiac events after uncomplicated myocardial infarction: a prospective study comparing predischarge exercise thallium-201 scintigraphy and coronary angiography.

The ability of predischarge quantitative exercise thallium-201 (201T1) scintigraphy to predict future cardiac events was evaluated prospectively in 140 consecutive patients with uncomplicated acute myocardial infarction; the results were compared with those of submaximal exercise treadmill testing and coronary angiography. High risk was assigned if scintigraphy detected 201T1 defects in more than one discrete vascular region, redistribution, or increased lung uptake, if exercise testing caused ST segment depression greater than or equal to 1 mm or angina or if angiography revealed multivessel disease. Low risk was designated if scintigraphy detected a single-region defect, no redistribution, or no increase in lung uptake, if exercise testing caused no ST segment depression or angina, or if angiography revealed single-vessel disease or no disease. By 15 +/- 12 months, 50 patients had experienced a cardiac event; seven died (five suddenly), nine suffered recurrent myocardial infarction, and 34 developed severe class III or IV angina pectoris. Compared with that of patients at low risk, the cumulative probability of a cardiac event was greater in high-risk patients identified by scintigraphy (p less than .001), exercise testing (p = .011), or angiography (p = .007). Scintigraphy predicted low-risk status better than exercise testing (p = .01) or angiography (p = .05). Each predicted mortality with equal accuracy. However, scintigraphy was more sensitive in detecting patients who experienced reinfarction or who developed class III or IV angina. When all 50 patients with events were combined, scintigraphy identified 47 high-risk patients (94%), whereas exercise-induced ST segment depression or angina detected only 28 (56%) (p less than .001). The presence of multivessel disease as assessed by angiography identified nine more patients with events than exercise testing (p = .06). However, the overall sensitivity of angiography was lower than that of scintigraphy (71% vs 94%; p less than .01) because three patients who experienced reinfarction and 10 who developed class III or IV angina had single-vessel disease. Importantly, 12 (92%) of these 13 patients with single-vessel disease who had an event exhibited redistribution on scintigraphy. These results indicate that (1) submaximal exercise 201T1 scintigraphy can distinguish high- and low-risk groups after uncomplicated acute myocardial infarction before hospital discharge; (2) 201T1 defects in more than one discrete vascular region, presence of delayed redistribution, or increased lung thallium uptake are more sensitive predictors of subsequent cardiac events than ST segment depression, angina, or extent of angiographic disease; and (3) low-risk patients are best identified by a single-region 201T1 defect without redistribution and no increased lung uptake.

Adult↗
PubMed1993

Accuracy of electronic digital calipers compared with quantitative angiography in measuring coronary arterial diameter.

BACKGROUND: Quantitative angiography is the accepted method for measuring coronary luminal diameter. Electronic digital calipers have been used to assess arterial diameters in vasomotor function studies and after interventional procedures. However, careful validation of calipers against quantitative angiography has not been described. METHODS AND RESULTS: We used digital calipers and quantitative angiography to measure 517 arterial diameters (88 nonstenotic segments) in 24 transplant patients undergoing vasomotor function studies with acetylcholine and nitroglycerin, 20 stenoses in 14 patients with coronary artery disease, and 15 stenoses in 15 patients before and after excimer laser-facilitated coronary angioplasty and at 6 months' follow-up. In nonstenotic arterial segments ranging in size from 0.6 to 3.5 mm, calipers overestimated diameters measured by quantitative angiography by 0.29 +/- 0.21 mm (mean +/- SD) (limits of agreement, -0.13 to 0.71 mm). However, when the vasomotor responses were expressed as percent diameter change, the two methods did not differ significantly (-1 +/- 10%; limits of agreement, -21% to 19%). In the 35 stenoses measured before intervention and 30 stenoses measured after intervention, calipers and quantitative angiography differed by 3 +/- 9% (limits of agreement, -15% to 21%) across a range of stenosis severity (11% to 80%). Repeat caliper measurements by the same observer of the percent diameter change in the transplant patients and the percent stenosis in the coronary artery disease patients led to standard deviations of the differences of 9.3% and 7.6%, respectively. Two different observers recorded percent diameter change and percent stenosis that differed with standard deviations of 9.6% and 7.8%, respectively. CONCLUSIONS: Quantitative angiography and electronic digital calipers produce similar relative changes in arterial diameters and percent stenosis in a broad range of severities. Digital calipers thus are a rapid and convenient alternative to computerized quantitative angiography in certain research studies and clinical practice of assessing stenosis severity.

Coronary Angiography↗
PubMed1996

Cost-effectiveness of routine coronary angiography after acute myocardial infarction.

BACKGROUND: Coronary angiography is indicated for many patients after acute myocardial infarction (AMI). There are a number of subgroups of AMI patients, however, for whom the indication for coronary angiography is not well established. METHODS AND RESULTS: We developed a decision-analytic model for AMI in representative patient subgroups based on relevant clinical characteristics. The model estimates quality-adjusted life expectancy and direct lifetime costs for two strategies: coronary angiography and treatment guided by its results versus initial medical therapy without angiography. Decision tree chance node probabilities were estimated with the use of pooled data from randomized clinical trials and other relevant literature, costs were estimated with the use of the Medicare Part A database, and quality of life adjustments were derived from a survey of 1051 patients who had had a recent AMI. In our analysis, incremental cost-effectiveness ratios for coronary angiography and treatment guided by its result, compared with initial medical therapy without angiography, ranged between $17,000 and > $1 million per quality-adjusted year of life gained. Patient subgroups with severe postinfarction angina or a strongly positive exercise tolerance test (ETT) typically had cost-effectiveness ratios of < $50,000 per quality-adjusted year of life gained. In addition, most patient subgroups with a prior AMI had cost-effectiveness ratios of < $50,000 per quality-adjusted year of life gained, even with a negative ETT result. CONCLUSIONS: In many patient subgroups after AMI, the cost-effectiveness of routine coronary angiography and treatment guided by its results compares favorably with other treatment strategies for coronary heart disease.

Adult↗