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Biomedical subjects

Mark D Morasch

Publications and source records attributed to Mark D Morasch.

At least 19 recordsLinked to original sources
PubMed2006

Sac behavior after aneurysm treatment with the Gore Excluder low-permeability aortic endoprosthesis: 12-month comparison to the original Excluder device.

BACKGROUND: The original Gore Excluder endoprosthesis (OGE) used both during and briefly after clinical trials was associated with less sac regression and more sac growth than some other devices, even without apparent endoleaks, presumably because of transmural movement of serous fluid across the expanded polytetrafluoroethylene material. In July 2004, the device was modified to decrease graft permeability. This study evaluated the efficacy of the new Excluder Low-Permeability Device (ELPD) at 1 year and compared it with the OGE and the Cook Zenith device (ZEN). METHODS: From Food and Drug Administration approval of the Excluder in November 2002 until June 2005, 283 patients underwent endovascular repair of abdominal aortic aneurysms with the Gore Excluder or the ZEN. Postoperative surveillance included computed tomographic scans at 1 and 12 months; 181 (64%) patients completed both scans. The 1-month computed tomographic scan served as a baseline, and the minor axis diameter, measured at the largest axial cut of the abdominal aortic aneurysm, was compared with the same measurement at 1 year. A sac size change of 5 mm or more was considered significant. Sixty patients treated with the OGE were compared with 72 patients treated with the ELPD. Forty-nine patients treated during the same time period with the ZEN, known for early sac shrinkage, were used as a reference. All measurements were performed by one observer from a digital workstation. Wilcoxon signed rank tests (pairwise) or Kruskal-Wallis tests (three groups) were used for intergroup comparison of continuous variables, whereas chi2 statistics or Fisher exact tests were used to compare categorical variables. RESULTS: Patient age and sex and mean maximum aneurysm diameter at baseline were similar among groups (P = .59, .27, and .46, respectively). Graft migration, stent fractures, acute surgical conversion, late abdominal aortic aneurysm rupture, or aneurysm-related deaths were not observed. Type II endoleak rates were similar between ELPD and ZEN (23.6% and 20.4%; P = .68). Although a higher rate of endoleaks was seen with OGE (36.7%), this was not significant when compared with the other two devices (P = .11). At 1 year, patients treated with ELPD had a sac regression rate that was significantly higher than that for patients treated with OGE (63.9% vs 25%; P < 0.001) and was similar to that for patients treated with ZEN (65.3%). Significant sac expansion was not observed with ELPD. CONCLUSIONS: At 1 year, similar to ZEN, significant aneurysm sac regression and minimal sac expansion were noted after endovascular repair of abdominal aortic aneurysms with ELPD. Low-porosity fabric used in the construction of endoprostheses seems to be an important factor in early aneurysm sac shrinkage. Long-term efficacy regarding the prevention of sac enlargement remains unclear, and further follow-up is suggested.

Aged↗
PubMed2006

Accuracy of stepping-table lower extremity MR angiography with dual-level bolus timing and separate calf acquisition: hybrid peripheral MR angiography.

PURPOSE: To retrospectively evaluate the accuracy of hybrid peripheral magnetic resonance (MR) angiography by using conventional digital subtraction angiography (DSA) as the reference standard. MATERIALS AND METHODS: This retrospective study protocol received approval from the Office of Sponsored Research at Northwestern University, which included review by the Office for the Protection of Research Subjects. Informed consent was waived for this HIPAA-compliant study. One hundred twenty-one consecutive patients (67 men: mean age, 66 years +/- 12 [standard deviation]; 54 women: mean age, 69 years +/- 14), who were referred for evaluation of peripheral vascular disease, underwent peripheral contrast material-enhanced MR angiography. By using a hybrid technique, two independent timing measurements were performed in the pelvis and calves followed by MR angiography of the calves and, subsequently, a pelvis-thigh stepping-table acquisition. Images were evaluated for extent of disease, on the basis of degree of stenosis; for venous contamination, on the basis of venous signal intensity; and for diagnostic quality, on the basis of diagnostic confidence of the observer. DSA correlation of the extent of vascular disease was available in 45 of these patients, which was used to evaluate the diagnostic power of the hybrid technique. RESULTS: For detection of stenosis greater than 50%, the hybrid technique had 95% sensitivity (P < .05), 95% specificity (P < .05), and 95% accuracy (P < .05). There was no significant venous contamination in any of the examinations performed with this technique. CONCLUSION: The hybrid peripheral MR angiography technique provides diagnostic-quality examinations and virtually eliminates venous contamination.

Adult↗
PubMed2006

Aortic arch vessel stenting: a single-center experience using cerebral protection.

HYPOTHESIS: Endovascular interventions have revolutionized the contemporary treatment of peripheral vascular occlusive disease. Traditional management of supra-aortic trunk disease has employed surgical extra-anatomic bypass via a cervical approach or median sternotomy. Endoluminal therapy may be a less morbid alternative. DESIGN AND SETTING: A retrospective review of procedures performed by vascular surgeons in an operating room angiosuite at a single university-based, tertiary referral center. PATIENTS: Eighteen consecutive patients with 20 brachiocephalic-origin stenoses. INTERVENTIONS: From December 2001 through September 2005, 20 brachiocephalic-origin stenoses were treated endoluminally with balloon-expandable stents. Treated vessels were innominate (n = 8), common carotid (n = 9), and subclavian (n = 3). The target lesion was accessed by one of the following methods: antegrade via the femoral artery (n = 5), retrograde through the brachial artery (n = 1), or via a retrograde cut-down on the common carotid artery (n = 14). Cerebral protection was achieved with either a distal embolic filter device or with open surgical occlusion of the distal common carotid artery. MAIN OUTCOME MEASURES: We report immediate and midterm outcomes of all aortic arch vessel stenting procedures with mean follow-up of 12 months. RESULTS: Mean age was 68 years (6 men and 12 women) and overall mean stenosis was 85%. Preprocedural symptoms including stroke, transient ischemic attack, arm fatigue, digital ischemia, and angina were present in 16 of 20 cases (80%). The 4 asymptomatic patients all had more than 90% stenosis on angiography. At 30-day follow-up, there were no deaths, myocardial infarctions, or strokes. During follow-up, there were no cases of restenosis. CONCLUSION: Endoluminal arterial stenting of brachiocephalic arch vessels may be a viable alternative to traditional open bypass in cases of focal stenotic disease.

Aged↗
PubMed2006

Multislice dark-blood carotid artery wall imaging: a 1.5 T and 3.0 T comparison.

PURPOSE: To compare two multislice turbo spin-echo (TSE) carotid artery wall imaging techniques at 1.5 T and 3.0 T, and to investigate the feasibility of higher spatial resolution carotid artery wall imaging at 3.0 T. MATERIALS AND METHODS: Multislice proton density-weighted (PDW), T2-weighted (T2W), and T1-weighted (T1W) inflow/outflow saturation band (IOSB) and rapid extended coverage double inversion-recovery (REX-DIR) TSE carotid artery wall imaging was performed on six healthy volunteers at 1.5 T and 3.0 T using time-, coverage-, and spatial resolution-matched (0.47 x 0.47 x 3 mm3) imaging protocols. To investigate whether improved signal-to-noise ratio (SNR) at 3.0 T could allow for improved spatial resolution, higher spatial resolution imaging (0.31 x 0.31 x 3 mm3) was performed at 3.0 T. Carotid artery wall SNR, carotid lumen SNR, and wall-lumen contrast-to-noise ratio (CNR) were measured. RESULTS: Signal gain at 3.0 T relative to 1.5 T was observed for carotid artery wall SNR (223%) and wall-lumen CNR (255%) in all acquisitions (P < 0.025). IOSB and REX-DIR images were found to have different levels of SNR and CNR (P < 0.05) with IOSB values observed to be larger. Normalized to a common imaging time, the higher spatial resolution imaging at 3.0 T and the lower spatial resolution imaging at 1.5 T provided similar levels of wall-lumen CNR (P = NS). CONCLUSION: Multislice carotid wall imaging at 3.0 T with IOSB and REX-DIR benefits from improved SNR and CNR relative to 1.5 T, and allows for higher spatial resolution carotid artery wall imaging.

Adult↗
PubMed2006

Endovascular repair of thoracic aortic tears.

BACKGROUND: Standard treatment of traumatic thoracic aortic transection (TTAT) is open repair by left thoracotomy with or without the use of partial cardiopulmonary bypass. However, open repair is associated with high rates of morbidity and mortality, particularly in multiply injured trauma patients. We reviewed our experiences of endovascular repair of acute TTAT. METHODS: Between February 2001 and February 2006, 30 patients (male 24, female 6, mean age 43 years) who had sustained severe blunt trauma with multiple injuries (mean injury severity score = 42) underwent endovascular repair for TTAT. Devices used included commercially available proximal abdominal aortic extension cuffs and thoracic stent-grafts. Either low dose or no systemic heparin was used. Arterial access was obtained by femoral-iliac cutdown (n = 19) or completely percutaneous through the femoral artery (n = 11). Mean follow-up was 11.6 months (range, 1 to 48 months). RESULTS: Technically success was achieved in 100% of patients, as determined by angiographic and computed tomographic (CT) scan exclusion of TTAT. Mean operating time was 132 minutes. Mean blood loss was 300 cm3. Three patients had complications: 1 iliac artery rupture, 1 cerebellar stroke, and 1 partial stent collapse. There were 2 perioperative deaths. There were no instances of procedure-related paralysis. Clinical and CT follow-up did not reveal evidence of endoleak, stent migration, or late pseudoaneurysm formation. CONCLUSIONS: The adaptation of commercially available stent-graft devices to treat TTAT is technically feasible, and can be performed with low rates of morbidity and mortality. The long-term durability of endovascular repair of TTAT remains unknown, but early and midterm results appear promising.

Accidents, Traffic↗
PubMed2006

Utility of left subclavian artery revascularization in association with endoluminal repair of acute and chronic thoracic aortic pathology.

BACKGROUND: A rapidly increasing number of thoracic aortic lesions are now treated by endoluminal exclusion by using stent grafts. Many of these lesions abut the great vessels and limit the length of the proximal landing zone. Various methods have been used to address this issue. We report our experience with subclavian artery revascularization in association with endoluminal repair of acute and chronic thoracic aortic pathology. METHODS: Thirty (43%) of 70 patients undergoing thoracic endovascular stent-graft placement from January 2001 to August 2005 had lesions adjacent to or involving the origin of the subclavian artery. The mean age was 62 years (range, 22-85 years; 63% were men, and 37% were women). This subgroup of 30 patients had indications for repair that included thoracic aortic aneurysm (n = 15), traumatic transection (n = 6), chronic dissection with pseudoaneurysm (n = 5), and acute dissection with intramural hematoma (n = 4). All 30 patients had the subclavian origin covered by the stent graft. In eight cases (27%), no effort was made to revascularize the subclavian artery before or during the endograft placement procedure. Twenty-three (77%) of 30 patients underwent subclavian to carotid artery transposition (n = 21) or bypass (n = 2) before (n = 12; average of 14 days before stent-graft placement), concomitant with (n = 10), or after (n = 1) the endovascular procedure. Physical examination and computed tomography scans were performed after surgery at 1, 6, and 12 months and annually thereafter. The mean follow-up was 18 months (range, 1-51 months). RESULTS: Five acute complications occurred in the eight patients (63%) who had the subclavian artery covered without pre-endograft revascularization and included four patients who experienced stroke (accounting for the only death) and one patient who developed symptomatic subclavian-vertebral steal that necessitated transposition 7 months later. Two (9%) of the 23 patients who had subclavian revascularization experienced left-sided vocal cord palsies, and 1 patient (4%) developed lower extremity paraparesis secondary to spinal cord ischemia. No late endoleaks related to retrograde sac perfusion from the most distal great vessel have been identified in any patient. CONCLUSIONS: Subclavian revascularization procedures can be performed with relatively low risk. Complications are rare, and patient recovery is rapid. Although this is not necessary in all cases, we advocate subclavian to carotid transposition when the aortic lesion is within 15 mm of the left subclavian orifice to prevent type II endoleak or perfusion of a dissected false lumen when the ipsilateral vertebral artery is patent and dominant or when coronary revascularization using an ipsilateral internal mammary artery is anticipated and in cases that necessitate extensive coverage of intercostals that contribute to spinal cord perfusion. Carotid to subclavian artery bypass should be reserved for patients with a patent internal mammary artery conduit perfusing a coronary vessel and should be combined with proximal subclavian ligation.

Acute Disease↗
PubMed2006

Decreased incidence of left common iliac vein compression in patients with abdominal aortic aneurysms.

OBJECTIVE: Compression of the left common iliac vein (LCIV) by the right common iliac artery is an anatomic variant that may increase the risk for LCIV thrombosis. The incidence of LCIV compression in patients with abdominal aortic aneurysms (AAA) is unknown, however. The aim of this descriptive anatomic study was to determine (1) the incidence of LCIV compression in patients with and without AAA and (2) if endovascular AAA repair acutely alters the incidence of LCIV compression and, hence, the risk of LCIV thrombosis. METHOD: A retrospective analysis of medical records and helical computed tomography (CT) scans was conducted in 100 AAA patients and 100 non-AAA patients (n = 200). Medical records were reviewed for symptoms and risk factors for deep vein thrombosis, and data were reported according to the Joint Society Reporting Standards for acute lower-extremity venous thrombosis. The minor diameters of the aorta, inferior vena cava, and common iliac arteries and veins were measured. For AAA patients, measurements were obtained from preoperative and 30-day postoperative CT scans. RESULTS: The mean age of the study cohort was 38 years (range, 17 to 85 years) for non-AAA subjects and 73 years (range, 51 to 89 years) for AAA subjects. The mean acute lower-extremity venous thrombosis risk factor score was low for both patient groups (non-AAA, 0.82 +/- 0.12; AAA, 2.63 +/- 0.14). Mean compression of the LCIV was 37.8% (range, 0% to 74.8%) for non-AAA patients but only 27.3% (range, 0% to 74.2%; P < .0006) for AAA patients. Of non-AAA patients with venous compression, the right common iliac artery was the compressing structure in 87% of cases. However, of AAA patients with venous compression, the left common iliac artery was the compressing structure in 76% of cases. There was no statistically significant change in the degree of compression of the LCIV before and after endovascular repair (27.3% vs 25.1%, respectively) nor was there a change in the structure that compressed the LCIV. CONCLUSION: Patients with AAA were found to have more tortuous iliac arteries that led to less anatomic compression of the LCIV compared with nonaneurysmal patients. Furthermore, the left common iliac artery was found to compress the LCIV in most of the AAA patients, and the right iliac artery was found to compress the LCIV in most non-AAA patients. Endovascular AAA repair did not acutely alter these anatomic findings. Patients with AAA may therefore be at lower risk of developing LCIV thrombosis owing to the nature of their anatomy.

Adolescent↗
PubMed2006

Abdominal aortic aneurysm-repair devices.

Traditional open aneurysm repair is associated with significant perioperative morbidity. The development of abdominal aneurysm-repair devices has provided a minimally invasive alternative to open repairs. The field of aneurysm-repair devices is burgeoning since the approval of the first device in 1999. A clear perioperative survival advantage and lower perioperative morbidity has been reported by multiple studies. In addition to benefiting the normal risk aortic aneurysm patient, this new technology is making the repair of aneurysms in older patients with high operative risk factors possible. Modifications to devices are introduced rapidly to overcome anatomical limitations and to improve on device-related complications such as endoleaks and migration. Limited long-term outcomes are available for newer devices, and life-long surveillance is still recommended for all patients. Patient selection and preoperative planning are the cornerstones to successful endovascular repair of abdominal aortic aneurysms.

Aortic Aneurysm, Abdominal↗
PubMed2005

The prophylactic use of inferior vena cava filters in patients undergoing high-risk spinal surgery.

Prophylactic inferior vena cava filter (IVCF) placement is advocated in some high-risk groups. We sought data regarding safety and efficacy for prophylactic IVCF placement in patients at high risk for venous thromboembolism (VTE) following major spinal reconstruction. Seventy-four spine surgery patients with contraindication to anticoagulation (44 females, 30 males; mean age 56.2) received prophylactic IVCFs. Criteria were (1) history of thromboembolism, (2) diagnosed thrombophilia, (3) malignancy, (4) bedridden >2 weeks prior to surgery, (5) staged procedures or multiple levels, (6) combined anterior/posterior approaches, (7) expected need for significant iliocaval manipulation during exposure, and (8) single-stage anesthetic time >8 hr. Seventy patients had at least two risk factors. All received IVCFs prior to the first stage of spine reconstruction. Patients were evaluated for filter complications, deep vein thrombosis (DVT), and pulmonary embolism (PE). Patients' lower extremity veins from groin to ankle were imaged weekly until discharge using duplex ultrasound (DUS). One-third also underwent thoracic and pelvic computed tomography scans, and the pelvic veins, IVC, and pulmonary vasculature were evaluated for VTE. Multiple DUS (n = 198, mean 2.6 studies per patient) were performed in 68 patients. At a mean follow-up of 11 months, one of the patients developed PE. Twenty-seven limbs in 23 patients developed DVT. Five limbs had isolated calf DVT, and 22 had proximal vein involvement. Insertion site DVT accounted for nearly one-third of the DVTs. Six patients died from unrelated complications. There was one technical error with an IVCF deployed in the iliac vein. Despite a high incidence of DVT following high-risk spinal surgery, prophylactic IVCF placement appears to protect patients from PE.

Adolescent↗
PubMed2005

Endovascular repair of thoracic aortic pathology with custom-made devices.

BACKGROUND: Open repair of thoracic aortic aneurysms (TAAs) is fraught with high morbidity and mortality rates. The availability of endoprostheses for treating thoracic aortic pathology has not kept pace with those for treating abdominal aneurysms. Technical feasibility, durability, and safety of custom-made stent-grafts for the treatment of TAAs and dissections are evaluated. METHODS: From July 2002 to October 2004 there were 15 patients with TAAs, intramural hematoma, or dissections treated with custom-made endografts. Grafts were deployed after brief adenosine-induced cardiac arrest. Computed tomography scans were obtained 1 month postoperatively and every 6 months thereafter. The mean follow-up period was 15 months (range, 3-31 mo). RESULTS: The mean age of patients was 67 +/- 11 years (range, 47-81 y; 67% men, 33% women). Indications for repair included TAA (10), chronic type B dissection (3), penetrating ulcer (1), and acute dissection (1). Planned concomitant procedures included subclavian-carotid transposition (2) and aortosplenic bypass (2) to achieve adequate proximal or distal landing seal zones, respectively. The mean length of hospital stay was 8 days (range, 1-49 d). Immediate complications included 2 access-related events, 1 cerebellar infarction treated expectantly, and 1 death from a large hemispheric stroke. There were no cases of postoperative paralysis and on follow-up imaging no cases of endoleak, endograft migration, or stent fractures were found. No late deaths occurred caused by stent-graft repair or aneurysm-related causes. CONCLUSIONS: Endoluminal exclusion of thoracic aortic aneurysms and dissections can be achieved successfully using custom-made stent-grafts. The use of specially designed devices appears to be technically feasible and durable, with acceptable morbidity and mortality rates.

Aged↗
PubMed2005

Prospective analysis of the incidence of deep venous thrombosis in bariatric surgery patients.

BACKGROUND: Venous thromboembolism (VTE), manifest as deep venous thrombosis (DVT) or pulmonary embolus, remains an important complication in bariatric operation patients. Our purpose was to determine the incidence of VTE in a consecutive series of patients undergoing Roux-en-Y gastric bypass (RYGB) to guide appropriate therapy. METHODS: We prospectively examined a consecutive series of RYGB patients with bilateral lower-extremity venous duplex scan (DS) preoperatively, on postoperative day (POD)#2, and approximately POD#14. Preoperative clinical information including history of VTE, intraoperative data, postoperative course, and complications were recorded. Heparin 5,000 U subcutaneously was administered before the operation and every 12 hours throughout hospitalization along with sequential compression devices. Ambulation was instituted on POD#1. Temporary caval filters were placed in patients with a history of VTE. RESULTS: A total of 106 patients were examined. Body mass index was 51 +/- 8 kg/m2 (range, 40-73 kg/m2). Laparoscopic RYGB was performed in 75%. Hospital length of stay was 2.5 +/- 0.6 days. One hundred patients had no history of VTE; none had a positive DS preoperatively or on POD#2. One patient had a positive POD#14 DS and a second patient had a superficial thrombophlebitis, but a negative DS for DVT (both patients were symptomatic). Six patients had a prior history of VTE; all underwent preoperative placement of a temporary caval filter. Of these 6 patients, 1 developed a new postoperative DVT and another patient had thrombus on the caval filter with a negative lower-extremity DS. CONCLUSIONS: Occult DVT was not observed preoperatively in RYGB patients, suggesting that routine preoperative DS is not necessary in the absence of VTE history. Prophylaxis of heparin and sequential compression devices appears satisfactory in preventing DVT with only a 1% incidence in patients with no prior history of VTE. Two of the 6 patients with prior history of VTE showed evidence of thrombus postoperatively. Although a small number of patients, this finding suggests that a caval filter should be placed preoperatively in RYGB patients with a history of VTE.

Adult↗
PubMed2005

Carotid stenting done exclusively by vascular surgeons: first 175 cases.

BACKGROUND: Percutaneous CAS may well replace CEA as standard of care. CAS has been performed largely by interventional cardiologists; however, with recent Food and Drug Administration approval, vascular surgeons are now hurriedly attempting to obtain the requisite endovascular skills. Reported are our 30-day and midterm outcomes of CAS. METHODS: Retrospective review of 175 cervical carotid stenoses treated with elective CAS from April 2001 to February 2005. All procedures were performed under local anesthesia via percutaneous femoral access in an operating room angiosuite. Mechanical cerebral protection was used in 90% of cases. Data analysis includes demographics, procedural records, and duplex exams over a mean follow-up of 21 months. RESULTS: Mean age is 70 years (74% men and 26% women). Preprocedural neurologic symptoms were present in 32%. Intraoperative complications included 2 seizures (1.1%) and 4 asystolic arrests (2.3%), all managed medically without sequelae. Over the 30-day follow-up there were no deaths, no myocardial infarctions (MIs), 2 major strokes (1.1%), 2 minor strokes (1.1%), 3 transient ischemic attacks (TIAs) (1.7%), and 1 major access-site complication (0.6%). At late follow-up, 3 cases (1.7%) of restenosis occurred; all were treated with repeat angioplasty and remain patent. One (0.6%) asymptomatic occlusion was detected at 6-month follow-up. There have been no late carotid-related complications or deaths. CONCLUSIONS: Vascular surgeons possessing advanced catheter-based skills can safely perform CAS and achieve perioperative results comparable to CEA. Such skills are crucial to those surgeons intent on the future management of carotid occlusive disease.

Aged↗
PubMed2005

Percutaneous endovascular repair of blunt thoracic aortic transection.

BACKGROUND: Untreated traumatic aortic transection carries a mortality rate higher than 85%. Standard therapy has been open repair via a left thoracotomy with systemic heparin and is associated with a high risk of paralysis. We reviewed our experience of endoluminal stent-graft repair for treatment of acute traumatic thoracic aortic transection. METHODS: Between February 2001 and February 2005, 11 patients sustaining severe blunt trauma with multiple injuries underwent acute endovascular repair for thoracic aortic transection with 'off-the-shelf' commercially available proximal aortic cuffs. No systemic heparin was used. Access to the aorta was obtained either through a femoral/iliac cutdown (n = 4) or percutaneously through the femoral artery (n = 7). Mean follow-up was 21 months (range, 3-49 months). RESULTS: Technically successful repair was achieved in 100% of patients, as determined by completion angiography demonstrating apposition of the stent-grafts to the aortic wall, normal perfusion of the aortic branches, and exclusion of the aortic transection without evidence of extravasation. None of the patients required secondary interventions, and there were no instances of death or paralysis. Patient follow-up, using computed tomography angiography, demonstrated durability of endovascular repair without evidence of endoleak, stent migration, or late pseudoaneurysm formation. CONCLUSION: Adaptation and use of commercially available abdominal devices in the thoracic aorta has proven to be technically feasible. Urgent repair of thoracic aortic transection in the setting of blunt trauma can be transformed into a well-tolerated surgical intervention using endovascular techniques. Long-term durability of endovascular repair of traumatic thoracic transections remains unknown, but early and midterm results are promising.

Accidents, Traffic↗
PubMed2005

New diagnostic imaging techniques.

Improvements in results after vascular intervention are partly due to advances in diagnostic imaging. The trend toward noninvasive diagnosis has also reduced patient exposure to undue risk. Normal and pathologic aortic, carotid, and lower-extremity vasculature can be imaged precisely by using a combination of ultrasound, computed tomography, and magnetic resonance imaging techniques before definitive open or minimally invasive reconstruction of occlusive or aneurysmal disease. These same imaging modalities, which were developed for the clinical management of patients, are also helping investigators study the biology of atherosclerosis in vivo in ways never before imagined.

Aortic Diseases↗
PubMed2005

Contrast-enhanced MR angiography of the carotid and vertebrobasilar circulations.

BACKGROUND AND PURPOSE: Contrast-enhanced MR angiography (CE MRA) is a proven diagnostic tool in evaluation of the carotid arteries; however, few studies have addressed its accuracy in the vertebrobasilar system. The purpose of this study was to assess the sensitivity and specificity of CE MRA compared with digital subtraction angiography (DSA) for detection of vertebrobasilar disease. METHODS: Forty patients with suspected atherosclerotic disease of the carotid and vertebrobasilar circulations underwent CE MRA on a 1.5 T MR imaging scanner by use of a coronal 3D gradient-echo pulse sequence after intravenous injection of gadolinium diethylene triamine penta-acetic acid. All patients had correlative DSA within a 1-month period. CE MRA images were randomized and then independently assessed by 2 observers who were blinded to the DSA results. DSA examinations were analyzed in a similar manner. Each observer was asked to report the presence or absence of clinically significant stenosis (>50%), occlusion, fistula, aneurysm, and dissection. The MRA findings were then correlated with DSA. RESULTS: The sensitivity and specificity of MRA for detection of disease in the entire carotid and vertebrobasilar systems were 90% and 97%, respectively; for the carotid system alone, the sensitivity and specificity were 94% and 97%, respectively; and for the vertebrobasilar system they were 88% and 98% respectively. The overall interobserver reliability was 98% (kappa = 0.92). CONCLUSION: CE MRA is accurate at detecting disease not only in the carotid vessels, but also in the vertebrobasilar circulation, and has the potential to provide a comprehensive and noninvasive evaluation of the head and neck arteries in a single study.

Aged↗