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At least 109 records · Page 6Linked to original sources
PubMed1996

Spiral CT angiography and selective digital subtraction angiography of internal carotid artery stenosis.

PURPOSE: To determine whether spiral CT angiography allows accurate, quantitative evaluation of anatomic abnormalities, including detection of additional lesions, delineation of plaque morphology, and estimation of degree of internal carotid artery stenosis. METHODS: Spiral CT angiography with a maximum intensity projection technique was compared with selective digital subtraction angiography (DSA) in 92 carotid arteries. The category of stenosis was determined according to the North American Symptomatic Carotid Endarterectomy Trial: mild (0% to 29%), moderate (30% to 69%), severe (70% to 99%), and occlusion (100%). RESULTS: In 78 (85%) of the 92 cases, spiral CT angiography and selective DSA demonstrated the same degree of stenosis. All occlusions (n = 19) were diagnosed correctly with spiral CT angiography. Spiral CT angiography agreed with selective DSA in the classification of stenosis in 59% of the group with mild stenosis, in 82% of the group with moderate stenosis, and in 90% of the group with severe stenosis. In the groups with mild (n = 13), moderate (n = 9), and severe (n = 27) stenosis, correlation of spiral CT angiography with selective DSA was significant. Calcified plaques were readily diagnosed with the use of spiral CT angiography but delineation of ulcers was poor. Tandem lesions were not visible owing to the limited coverage. CONCLUSION: Spiral CT angiography is useful for the detection of proximal internal carotid stenoses that are greater than 30%. Depiction of mild stenoses appears to be limited. CT is superior for the detection of calcified plaques but it is not useful for the detection of ulcers.

Adult↗
PubMed2003

Characteristics and outcome of patients with ST-elevation infarction in relation to whether they received thrombolysis or underwent acute coronary angiography: are we selecting the right patients for coronary angiography?

BACKGROUND: During the last decade, there has been an on-going debate with regard to whether percutaneous coronary intervention (PCI) or thrombolysis should be preferred in patients with ST-elevation acute myocardial infarction (AMI). Some studies clearly advocate PCI, while others do not. HYPOTHESIS: The study aimed to describe the characteristics and to evaluate outcome of patients with suspected ST-elevation or left bundle-branch block infarction in relation to whether they received thrombolysis or had an acute coronary angiography aiming at angioplasty. METHODS: The study included all patients admitted to Sahlgrenska University Hospital in Göteborg, Sweden, with suspected acute myocardial infarction who, during 1995-1999, had ST-elevation or left bundle-branch block on admission electrocardiogram (ECG) requiring either thrombolysis or acute coronary angiography. A retrospective evaluation with a follow-up of 1 year after the intervention was made. RESULTS: In all, 413 patients had thrombolytic treatment and 400 had acute coronary angiography. The patients who received thrombolysis were older (mean age 70.3 vs. 64.1 years). Mortality during 1 year of follow-up was 20.9% in the thrombolysis group and 16.6% in the angiography group (p = 0.12). Among patients in whom acute coronary angiography was performed, only 85% underwent acute percutaneous coronary intervention (PCI). There was a mortality of 12.1 vs. 41.7% among those who did not undergo acute PCI. Development of reinfarction, stroke, and requirement of rehospitalization was similar regardless of type of initial intervention. The thrombolysis group more frequently required new coronary angiography (36.9 vs. 20.6%; p<0.0001) and new PCI (17.8 vs. 11.9%; p = 0.01). Despite this, after 1 year symptoms of angina pectoris were observed in 27% of patients in the thrombolysis group and in only 14% of those in the angiography group (p = 0.0002). CONCLUSION: In a Swedish university hospital with a high volume of coronary angioplasty procedures, we found no significant difference in mortality between patients who had thrombolysis and those who underwent acute coronary angiography. However, requirement of revascularization and symptoms of angina pectoris 1 year later was considerably less frequent in those who had undergone acute coronary angiography. However, distribution of baseline characteristics was skewed and efforts should be focused on the selection of patients for the different reperfusion strategies.

Aged↗
PubMed1998

A prospective randomized trial of triage angiography in acute coronary syndromes ineligible for thrombolytic therapy. Results of the medicine versus angiography in thrombolytic exclusion (MATE) trial.

OBJECTIVES: The purpose of this study was to determine if early triage angiography with revascularization, if indicated, favorably affects clinical outcomes in patients with suspected acute myocardial infarction who are ineligible for thrombolysis. BACKGROUND: The majority of patients with acute myocardial infarction and other acute coronary syndromes are considered ineligible for thrombolysis and therefore are not afforded the opportunity for early reperfusion. METHODS: This multicenter, prospective, randomized trial evaluated in a controlled fashion the outcomes following triage angiography in acute coronary syndromes ineligible for thrombolytic therapy. Eligible patients (n=201) with <24 h of symptoms were randomized to early triage angiography and subsequent therapies based on the angiogram versus conventional medical therapy consisting of aspirin, intravenous heparin, nitroglycerin, beta-blockers, and analgesics. RESULTS: In the triage angiography group, 109 patients underwent early angiography and 64 (58%) received revascularization, whereas in the conservative group, 54 (60%) subsequently underwent nonprotocol angiography in response to recurrent ischemia and 33 (37%) received revascularization (p=0.004). The mean time to revascularization was 27+/-32 versus 88+/-98 h (p=0.0001) and the primary endpoint of recurrent ischemic events or death occurred in 14 (13%) versus 31 (34%) of the triage angiography and conservative groups, respectively (45% risk reduction, 95% CI 27-59%, p=0.0002). There were no differences between the groups with respect to initial hospital costs or length of stay. Long-term follow-up at a median of 21 months revealed no significant differences in the endpoints of late revascularization, recurrent myocardial infarction, or all-cause mortality. CONCLUSIONS: Early triage angiography in patients with acute coronary syndromes who are not eligible for thrombolytics reduced the composite of recurrent ischemic events or death and shortened the time to definitive revascularization during the index hospitalization. Despite more frequent early revascularization after triage angiography, we found no long-term benefit in cardiac outcomes compared with conservative medical therapy with revascularization prompted by recurrent ischemia.

Adult↗
PubMed2000

Videodensitometric quantitative angiography after coronary balloon angioplasty, compared to edge-detection quantitative angiography and intracoronary ultrasound imaging.

AIMS: To assess the value of videodensitometric quantification of the coronary lumen after angioplasty by comparison to two other techniques of coronary artery lumen quantification. METHODS AND RESULTS: Videodensitometric quantitative angiography, edge detection quantitative angiography and 30 MHz intracoronary ultrasound imaging were performed after successful balloon angioplasty in 161 patients. Lumen cross-sectional areas were mean (SD) 2.82 (1.15) mm(2)for edge detection quantitative angiography, 3.67 (1.5) mm(2)for videodensitometric quantitative angiography and 5.32 (1.75) mm(2)for intracoronary ultrasound imaging (P<0.001). The correlation between intracoronary ultrasound imaging and videodensitometric quantitative angiography (r=0.44) was almost similar to that of intracoronary ultrasound imaging and edge detection quantitative angiography (r=0. 47). The correlation between the three techniques was not significantly influenced by the presence of ruptures and dissections on intracoronary ultrasound imaging. The absence of calcifications improved the correlation between videodensitometry and intracoronary ultrasound imaging. CONCLUSIONS: The luminal dimensions as measured by videodensitometric quantitative angiography matched intracoronary ultrasound imaging derived dimensions more closely than edge detection quantitative angiography. Videodensitometric quantitative angiography represents an on-line alternative to intracoronary ultrasound imaging for quantitative analysis regardless of the degree of vessel damage.

Absorptiometry, Photon↗
PubMed1993

Diagnosis of disease of the common carotid artery bifurcation: CT angiography vs catheter angiography.

OBJECTIVE: The purpose of this prospective study was to compare CT angiography with conventional catheter angiography for imaging the bifurcation of the common carotid artery in patients with signs and symptoms of atherosclerotic disease. SUBJECTS AND METHODS: Ten symptomatic patients (20 bifurcations of the common carotid artery) underwent contrast-enhanced spiral CT of the neck. The images were preprocessed and postprocessed by using a commercially available volume-rendering technique and a maximum-intensity-projection algorithm. All patients subsequently underwent conventional catheter angiography. RESULTS: CT angiographic findings matched those on conventional angiograms in only 50% of cases. Two nearly occluded internal carotid arteries were missed with CT angiography. Four internal carotid arteries were interpreted as occluded on the basis of CT angiograms but were shown as patent on catheter angiograms. Of five severe stenoses shown by CT angiography, only two were confirmed by conventional angiography. CONCLUSION: The results indicate that CT angiography as used in this study cannot replace catheter angiography. With CT angiography, both overestimation and underestimation of stenoses occur.

Angiography↗
PubMed2002

Peripheral vascular disease: combined 3D bolus chase and dynamic 2D MR angiography compared with x-ray angiography for treatment planning.

PURPOSE: To compare combined three-dimensional (3D) and two-dimensional (2D) contrast material-enhanced magnetic resonance (MR) angiography with x-ray angiography for planning treatment of peripheral vascular disease. MATERIALS AND METHODS: Three radiologists retrospectively reviewed the pretreatment x-ray angiographic and MR angiographic studies obtained in 30 consecutive patients: 15 patients (15 limbs) evaluated for limb salvage and 15 patients (20 limbs) evaluated because of claudication. MR angiography included acquisition of 2D contrast-enhanced MR digital subtraction angiograms of the area from the adductor canal to the feet and 3D spoiled gradient-recalled-echo bolus chase MR angiograms obtained in three stations from the aorta to the middle portion of the calf. Each reader reviewed the x-ray and MR angiograms to determine the inflow and outflow segments for a hypothetical bypass graft placement. RESULTS: The three readers selected identical segments for inflow at MR angiography and x-ray angiography in 32, 32, and 35 of the 35 limbs evaluated (mean percentages of agreement [95% CI ]: 91% [77%, 98%], 91% [77%, 98%], and 95% [90%, 100%], respectively). The readers selected identical segments for outflow in 32, 32, and 34 of the 35 limbs evaluated (mean percentages of agreement [95% CI]: 91% [77%, 98%], 91% [77%, 98%], and 97% [85%, 100%], respectively). CONCLUSION: Preliminary data support the combining of 2D MR digital subtraction angiography with 3D bolus chase MR angiography to extend the utility of 3D MR angiography in treatment planning to include patients being evaluated for limb salvage, as well as those being evaluated for claudication.

Adult↗
PubMed2001

Follow-up of intracranial aneurysms treated with detachable coils: comparison of gadolinium-enhanced 3D time-of-flight MR angiography and digital subtraction angiography.

PURPOSE: To compare three-dimensional (3D) time-of-flight magnetic resonance (MR) angiography with digital subtraction angiography (DSA) in the follow-up of intracranial aneurysms treated with selective endovascular placement of detachable coils. MATERIALS AND METHODS: Sixty-eight consecutive patients with intracranial aneurysms were included in the prospective study. The goal was to evaluate 3D time-of-flight MR angiography versus DSA for the detection of a residual aneurysm neck or residual flow inside the coil mesh. RESULTS: Eighty-one MR angiographic and 83 DSA examinations were performed; 15 patients were examined with both modalities twice. MR angiography was not possible in two patients. In another patient, the quality of MR angiography was not sufficient to assess the treated aneurysm. In 72 of the remaining 80 MR angiographic and DSA examinations, there was good correlation between the two modalities. In 54 cases, neither image type showed remnants or recurrence, but in 18, both showed residual aneurysm. In eight cases, the MR angiographic and DSA results differed. In one of these cases, MR angiography depicted residual aneurysm but DSA depicted an arterial loop. In seven cases, a small (<3-mm) remnant was not detected at MR angiography. CONCLUSION: Because very small aneurysm remnants or recurrences probably are not clinically important, MR angiography is an option for following up intracranial aneurysms treated with detachable coils and may partly replace DSA.

Adult↗
PubMedDate not supplied

Routine use of three-dimensional contrast-enhanced moving-table MR angiography in patients with peripheral arterial occlusive disease: comparison with selective digital subtraction angiography.

PURPOSE: To compare the diagnostic accuracy of contrast-enhanced (CE) three-dimensional (3D) moving-table magnetic resonance (MR) angiography with that of selective digital subtraction angiography (DSA) for routine clinical investigation in patients with peripheral arterial occlusive disease. METHODS: Thirty-eight patients underwent CE 3D moving-table MR angiography of the pelvic and peripheral arteries. A commercially available large-field-of-view adapter and a dedicated peripheral vascular phased-array coil were used. MR angiograms were evaluated for grade of arterial stenosis, diagnostic quality, and presence of artifacts. MR imaging results for each patient were compared with those of selective DSA. RESULTS: Two hundred and twenty-six arterial segments in 38 patients were evaluated by both selective DSA and MR angiography. No complications related to MR angiography were observed. There was agreement in stenosis classification in 204 (90.3%) segments; MR angiography overgraded 16 (7%) segments and undergraded 6 (2.7%) segments. Compared with selective DSA, MR angiography provided high sensitivity and specificity and excellent interobserver agreement for detection of severe stenosis (97% and 95%, kappa = 0.9 +/- 0.03) and moderate stenosis (96.5% and 94.3%, kappa = 0.9 +/- 0.03). CONCLUSION: Compared with selective DSA, moving-table MR angiography proved to be an accurate, noninvasive method for evaluation of peripheral arterial occlusive disease and may thus serve as an alternative to DSA in clinical routine.

Aged↗
PubMed2005

Assessing the appropriateness and increasing the yield of renal angiography in patients undergoing coronary angiography: a scoring system.

The real appropriateness and yield of a coincident renal angiography in patients undergoing coronary angiography is still a matter of debate. We have attempted to defined a scoring system to assess the need for renal angiography in patients undergoing diagnostic coronary angiography. We retrospectively reviewed our invasive cardiology database searching for patients underwent coincident screening abdominal aorta angiography to detect occult renal artery stenosis were analyzed and entry in a development set. Univariate and multivariate logistic regression analyses were employed to determine independent predictors of extra-cardiac atherosclerotic involvement. Based on the odds ratio, identified variables were assigned to a weighted integer; the sum of integers was a total score. Thus, the scoring model was tested on a validation set based on a prospective series of consecutive patients enrolled on the basis of an identified cut-off score. In the development set (635 patients, mean age 68+/-11.2 years) an angiographically significant RAS was observed in 20% of cases (128 patients). The rate of significant angiographic findings increased proportionally with increasing risk score (Pearson coefficient 0.98). A score of >or=5 was identified to be the cut-off beyond which renal angiography seems to have a sufficiently good efficacy in detecting clinically significant renal artery diseases (>30% of patients). In the validation set the patients were enrolled on the basis of the identified cut-off score (317 patients, mean age 69+/-14.1 years): angiographic occult RAS was diagnosed in 156/317 (49.2%) patients of the validation set versus 128/635 (20%) patients of the development set, p<0.01. This scoring system, once applied in standard medium-high volume cath labs, may be effective in increasing the yield of renal artery angiography in patients undergoing coronary angiography.

Aged↗
PubMed2003

Prospective blinded evaluation of Gd-DOTA- versus Gd-BOPTA-enhanced peripheral MR angiography, as compared with digital subtraction angiography.

PURPOSE: To compare the diagnostic accuracy of gadobenate dimeglumine (Gd-BOPTA)-enhanced versus gadoterate meglumine (Gd-DOTA)-enhanced magnetic resonance (MR) angiography in patients with peripheral arterial occlusive disease (PAOD). MATERIALS AND METHODS: Fifty-six patients underwent MR angiography enhanced with either Gd-DOTA (28 patients) or Gd-BOPTA (28 patients). All arterial segments from the renal arteries to the distal run-off vessels were evaluated for disease severity. The sensitivity, specificity, and accuracy of MR angiography enhanced with both agents separately were evaluated with a paired t test; digital subtraction angiography was the reference standard. Interobserver variability was assessed by using the Cohen test. RESULTS: Diagnostic MR angiograms were obtained in all 56 patients. Overall, sensitivity and specificity of Gd-DOTA-enhanced MR angiography were 96% and 93%, respectively, for observer 1 and 96% and 85%, respectively, for observer 2 (kappa = 0.82). Corresponding values for Gd-BOPTA-enhanced MR angiography were 94% and 93%, respectively, for observer 1 and 94% and 89%, respectively, for observer 2 (kappa = 0.78). No consistent differences between the two contrast materials in assessment of PAOD in the renal to popliteal arteries were observed. For assessment below the knee, specificity was slightly higher in the Gd-BOPTA group-91% and 84% for observers 1 and 2, respectively-than in the Gd-DOTA group-89% and 77%, respectively (P <.01). The number of nonassessable below-the-knee segments was significantly lower in the Gd-BOPTA group: nine of 299 segments versus 25 of 312 segments in the Gd-DOTA group (P <.01). CONCLUSION: At MR angiography of the distal run-off vessels, Gd-BOPTA yielded higher specificity and a significantly smaller number of nonassessable segments than Gd-DOTA. The diagnostic accuracy of the two gadolinium chelates at peripheral MR angiography was comparable in the renal to popliteal arteries.

Adult↗
PubMed1995

Moyamoya disease: comparison of assessment with MR angiography and MR imaging versus conventional angiography.

PURPOSE: To evaluate magnetic resonance (MR) angiography and MR imaging in assessment of moyamoya disease. MATERIALS AND METHODS: The cases of 26 patients with moyamoya disease were evaluated prospectively. After three-dimensional time-of-flight 1.5-T MR angiography and MR imaging, images were evaluated in blinded separate interpretation. RESULTS: MR angiography and MR imaging accurately depicted 217 (82%) and 184 (70%) of 264 arteries, respectively, but the degree of stenosis was overestimated in the other arteries. Basal cerebral moyamoya vessels were depicted in all 52 hemispheres with conventional angiography and in 42 (81%) and 48 (92%) hemispheres with MR angiography and MR imaging, respectively. The respective sensitivity and specificity for diagnosis of moyamoya disease were 73% and 100% for MR angiography, 92% and 100% for MR imaging, and 92% and 100% for MR angiography plus MR imaging. CONCLUSION: Assessment of moyamoya disease is most thorough with MR angiography and MR imaging.

Adolescent↗