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Cardiology Journal 2023Assessment of collaterals physiology in chronic total occlusions (CTO) currently requires dedicated devices, adds complexity, and increases the cost of the intervention....
BACKGROUND
Assessment of collaterals physiology in chronic total occlusions (CTO) currently requires dedicated devices, adds complexity, and increases the cost of the intervention. This study sought to derive collaterals physiology from flow velocity changes (ΔV) in donor arteries, calculated with artificial intelligence- aided angiography.
METHODS
Angiographies with successful percutaneous coronary intervention (PCI) in 2 centers were retro- spectively analyzed. CTO collaterals were angiographically evaluated according to Rentrop and collateral connections (CC) classifications. Flow velocities in the primary and secondary collateral donor arteries (PCDA, SCDA) were automatically computed pre and post PCI, based on a novel deep-learning model to extract the length/time curve of the coronary filling in angiography. Parameters of collaterals physiology, Δcollateral-flow (Δfcoll) and Δcollateral-flow-index (ΔCFI), were derived from the ΔV pre-post.
RESULTS
The analysis was feasible in 105 out of 130 patients. Flow velocity in the PCDA significantly decreased after CTO-PCI, proportionally to the angiographic collateral grading (Rentrop 1: 0.02 ± 0.01 m/s; Rentrop 2: 0.04 ± 0.01 m/s; Rentrop 3: 0.07 ± 0.02 m/s; p < 0.001; CC0: 0.01 ± 0.01 m/s; CC1: 0.04 ± ± 0.02 m/s; CC2: 0.06 ± 0.02 m/s; p < 0.001). Δfcoll and ΔCFI paralleled ΔV. SCDA also showed a greater reduction in flow velocity if its collateral channels were CC1 vs. CC0 (0.03 ± 0.01 vs. 0.01 ± 0.01 m/s; p < 0.001). For each individual patient, ΔV was more pronounced in the PCDA than in the SCDA.
CONCLUSIONS
Automatic assessment of collaterals physiology in CTO is feasible, based on a deeplearning model analyzing the filling of the donor vessels in angiography. The changes in collateral flow with this novel method are quantitatively proportional to the angiographic grading of the collaterals.
Topics: Humans; Percutaneous Coronary Intervention; Coronary Occlusion; Artificial Intelligence; Coronary Angiography; Treatment Outcome; Collateral Circulation; Chronic Disease; Coronary Circulation
PubMed: 36117292
DOI: 10.5603/CJ.a2022.0089 -
Current Eye Research May 2023The optic nerve mechanically loads the eye during ocular rotation, thus altering the configuration of the disk and peripapillary tissues. We used optical coherence...
PURPOSE
The optic nerve mechanically loads the eye during ocular rotation, thus altering the configuration of the disk and peripapillary tissues. We used optical coherence tomography (OCT) angiography (OCTA) to investigate mechanical strains and volume changes in disk and peripapillary blood vessels during horizontal duction.
METHODS
Structural OCT and OCTA were performed centered on optic disks; imaging was repeated in central gaze, and in 30° ab- and adduction. By an algorithm employing point-set registration of 3 D features, we developed a novel approach for measuring disk strains, and strains and volumes of the blood vessels associated with horizontal duction. Repeatability was demonstrated in each gaze position.
RESULTS
19 eyes of 10 healthy adults of average age 37 ± 15 (standard deviation, SD) years were imaged. The method was validated by demonstrating numerically consistent vascular volumes and strains for repeated imaging under identical conditions. Compared with central gaze, vascular volume increased by 5.2 ± 4.1% in adduction. Adduction and abduction caused strains of 3.0 ± 1.6% and 2.6 ± 1.8% in the optic disk, whereas blood vessels showed greater strains of 8.1 ± 1.3% and 8.2 ± 1.7%. Decomposition of strain components depending on directionality and regions demonstrated that adduction induces significant net tensile strains, suggesting traction exerted by the optic nerve. The decomposition also showed that nasotemporal compressive strains are larger in temporal hemidisks than nasal hemidisks. The Bruch's membrane opening was significantly compressed horizontally in adduction by 1.1% ( = .009).
CONCLUSION
This novel analysis combining structural OCT and OCTA demonstrates that optic disk compression during adduction is associated with disk and vascular strains much larger than reported for intraocular pressure elevation and pulsatile perfusion, as well as compressing the disk and increasing peripapillary vascular volume. These changes may be relevant to the pathogenesis of optic nerve and retinal vascular disorders.
Topics: Adult; Humans; Young Adult; Middle Aged; Optic Disk; Tomography, Optical Coherence; Optic Nerve Diseases; Optic Nerve; Angiography; Intraocular Pressure; Retinal Vessels; Fluorescein Angiography
PubMed: 36843550
DOI: 10.1080/02713683.2023.2172185 -
Circulation. Cardiovascular Imaging Jun 2023The optimal diagnostic strategy for patients with chest pain and detectable to mildly elevated serum troponin is not known. The objective was to compare clinical... (Randomized Controlled Trial)
Randomized Controlled Trial
Cardiac Magnetic Resonance Imaging Versus Invasive-Based Strategies in Patients With Chest Pain and Detectable to Mildly Elevated Serum Troponin: A Randomized Clinical Trial.
BACKGROUND
The optimal diagnostic strategy for patients with chest pain and detectable to mildly elevated serum troponin is not known. The objective was to compare clinical outcomes among an early decision for a noninvasive versus an invasive-based care pathway.
METHODS
The CMR-IMPACT trial (Cardiac Magnetic Resonance Imaging Strategy for the Management of Patients with Acute Chest Pain and Detectable to Elevated Troponin) was conducted at 4 United States tertiary care hospitals from September 2013 to July 2018. A convenience sample of 312 participants with acute chest pain symptoms and a contemporary troponin between detectable and 1.0 ng/mL were randomized early in their care to 1 of 2 care pathways: invasive-based (n=156) or cardiac magnetic resonance (CMR)-based (n=156) with modification allowed as the patient condition evolved. The primary outcome was a composite including death, myocardial infarction, and cardiac-related hospital readmission or emergency visits.
RESULTS
Participants (N=312, mean age, 60.6 years, SD 11.3; 125 women [59.9%]), were followed over a median of 2.6 years (95% CI, 2.4-2.9). Early assigned testing was initiated in 102 out of 156 (65.3%) CMR-based and 110 out of 156 (70.5%) invasive-based participants. The primary outcome (CMR-based versus invasive-based) occurred in 59% versus 52% (hazard ratio, 1.17 [95% CI, 0.86-1.57]), acute coronary syndrome after discharge 23% versus 22% (hazard ratio, 1.07 [95% CI, 0.67-1.71]), and invasive angiography at any time 52% versus 74% (hazard ratio, 0.66 [95% CI, 0.49-0.87]). Among patients completing CMR imaging, 55 out of 95 (58%) were safely identified for discharge based on a negative CMR and did not have angiography or revascularization within 90 days. Therapeutic yield of angiography was higher in the CMR-based arm (52 interventions in 81 angiographies [64.2%] versus 46 interventions in 115 angiographies [40.0%] in the invasive-based arm [=0.001]).
CONCLUSIONS
Initial management with CMR or invasive-based care pathways resulted in no detectable difference in clinical and safety event rates. The CMR-based pathway facilitated safe discharge, enriched the therapeutic yield of angiography, and reduced invasive angiography utilization over long-term follow-up.
REGISTRATION
URL: https://www.
CLINICALTRIALS
gov; Unique identifier: NCT01931852.
Topics: Humans; Female; Middle Aged; Troponin; Heart; Chest Pain; Myocardial Infarction; Magnetic Resonance Imaging; Coronary Angiography
PubMed: 37339173
DOI: 10.1161/CIRCIMAGING.122.015063 -
Clinical Neuroradiology Sep 2022Spinal dural arteriovenous fistulas (SDAVFs) represent the most common indication for a spinal angiography. The diagnostic reference level (DRL) for this specific...
PURPOSE
Spinal dural arteriovenous fistulas (SDAVFs) represent the most common indication for a spinal angiography. The diagnostic reference level (DRL) for this specific endovascular procedure is still to be determined. This single-center study provides detailed dosimetrics of diagnostic spinal angiography performed in patients with SDAVFs.
METHODS
Retrospective analysis of all diagnostic spinal angiographies between December 2011 and January 2021. Only patients with an SDAVF who had baseline magnetic resonance angiography (MRA), diagnostic digital subtraction angiography (DSA), treatment and follow-up at this institution were included. Dose area product (DAP, Gy cm) and fluoroscopy time were compared between preoperative and postoperative angiographies, according to SDAVF locations (common versus uncommon), MRA results at baseline (positive versus negative) and DSA protocols (low-dose, mixed-dose, normal-dose). The 75th percentile of the DAP distribution was used to define the local DRL.
RESULTS
A total of 62 spinal angiographies were performed in 25 patients with SDAVF. Preoperative angiographies (30/62, 48%) yielded a significantly higher DAP and longer fluoroscopy time when compared to postoperative angiographies (32/62, 53%) (p < 0.01). The local DRL was 329.41 Gy cm for a nonspecific (n = 62), 395.59 Gy cm for a preoperative and 138.6 Gy cm for a postoperative spinal angiography. Preoperative angiography of uncommonly located SDAVFs yielded a significantly longer fluoroscopy time (p = 0.02). The MRA-based fistula detection had no significant impact on dosimetrics (p > 0.05). A low-dose protocol yielded a 61% reduction of DAP.
CONCLUSION
The results of the present study suggest novel DRLs for spinal angiography in patients with SDAVF. Dedicated low-dose protocols enable radiation dose optimization in these procedures.
Topics: Angiography, Digital Subtraction; Central Nervous System Vascular Malformations; Fluoroscopy; Humans; Radiation Dosage; Retrospective Studies
PubMed: 34994809
DOI: 10.1007/s00062-021-01130-1 -
Interventional Neuroradiology : Journal... Aug 2020The objective of this study was to assess the efficacy and safety of transradial access for diagnostic angiography and interventional neuroradiology procedures.
PURPOSE
The objective of this study was to assess the efficacy and safety of transradial access for diagnostic angiography and interventional neuroradiology procedures.
METHODS
This was a retrospective analysis of a single-center experience based on 225 patients attended between August 2015 and October 2019, in which transradial access was used for diagnostic angiography and endovascular interventions. Ultrasound-guided access was done at the level of the forearm or anatomical or snuffbox (distal transradial access). Conventional forearm transradial access was done in 179 procedures (right, left and bilateral in 169, 5 and 5, respectively), while distal transradial access was done in 46 cases (41 right and 5 left). Primary outcome measures included successful catheterization, need to change access, or technical complications.
RESULTS
In the group of 131 diagnostic angiographies, the technique success rate was 100% to target the right vertebral artery, 97% for the right internal carotid, 93.5% for the left internal carotid, 82% for the left vertebral artery, and 100% for both common and external carotid arteries. All patients were discharged within 2-4 h after the procedure. A total of 94 interventional procedures were performed, including aneurysms in 39 cases, stroke in 34, and other procedures (carotid stents, arteriovenous malformations, carotid-cavernous fistula) in the remaining 21. The overall technical success in both diagnostic angiographies and interventional procedures was 97.7%. In four cases of diagnostic angiography and in 1 intervention, it was necessary to switch from transradial access to transfemoral access. Three cases of hematoma related to the access site were recorded.
CONCLUSIONS
In our experience, transradial access is an alternative approach for diagnostic angiography and neuro-interventions.
Topics: Aged; Aged, 80 and over; Catheterization; Cerebral Angiography; Cerebrovascular Disorders; Endovascular Procedures; Female; Humans; Male; Radial Artery; Retrospective Studies; Ultrasonography
PubMed: 32408785
DOI: 10.1177/1591019920925711 -
Graefe's Archive For Clinical and... Feb 2023
Topics: Humans; Tomography, Optical Coherence; Retinal Diseases; Choroid; Angiography; Fluorescein Angiography; Retinal Vessels
PubMed: 36322215
DOI: 10.1007/s00417-022-05879-0 -
Radiology Sep 2022
Topics: Humans; Magnetic Resonance Angiography; Phlebography
PubMed: 35536135
DOI: 10.1148/radiol.213208 -
Plastic and Reconstructive Surgery Jun 2022Perforator imaging is a prerequisite in preoperative planning of the peroneal perforator flap and the fibula skin island. Although reports indicate that indocyanine...
BACKGROUND
Perforator imaging is a prerequisite in preoperative planning of the peroneal perforator flap and the fibula skin island. Although reports indicate that indocyanine green angiography assessment method might be advantageous over conventional ultrasound-based techniques (i.e., Doppler and color duplex), in practice, clear evidence is lacking. Thus, a comparative assessment of the utility of indocyanine green angiography and ultrasound-based techniques in the identification of suitable lower leg skin perforators was performed.
METHODS
A prospective clinical cohort study with a series of 12 consecutive patients was conducted to assess indocyanine green angiography, Doppler ultrasound, and color duplex ultrasound techniques for preoperative perforator detection in the lower leg before free fibula flap harvest. Anatomical dissection served as a reference. Parameters measured were perforator spatial distance to the reference (precision), operative time expenditure, and ease of device usage for assessment/outcomes.
RESULTS
This study included 12 patients, with a total of 27 perforators. Exhibition of technique sensitivity and positive predictive values were as follows: indocyanine green angiography, 93 percent and 100 percent; Doppler ultrasound, 82 percent and 82 percent; and color duplex ultrasound, 89 percent and 86 percent, respectively. With regard to the indocyanine green angiography technique, the distance to the actual perforator location was significantly shorter, which aided detection and lesser time expenditure during operation.
CONCLUSIONS
The indocyanine green angiography technique proved to have high precision, sensitivity, positive predictive value, and easy-to-use capabilities because of its exceptional spatial and temporal information, compared to the conventional, ultrasound-based techniques. Therefore, indocyanine green angiography is superior for preoperative perforator imaging of the lateral lower leg.
CLINICAL QUESTION/LEVEL OF EVIDENCE
Diagnostic, II.
Topics: Angiography; Cohort Studies; Humans; Indocyanine Green; Perforator Flap; Prospective Studies; Tibial Arteries
PubMed: 35426887
DOI: 10.1097/PRS.0000000000009131 -
AJNR. American Journal of Neuroradiology Oct 2021By means of artificial intelligence, 3D angiography is a novel postprocessing method for 3D imaging of cerebral vessels. Because 3D angiography does not require a mask...
BACKGROUND AND PURPOSE
By means of artificial intelligence, 3D angiography is a novel postprocessing method for 3D imaging of cerebral vessels. Because 3D angiography does not require a mask run like the current standard 3D-DSA, it potentially offers a considerable reduction of the patient radiation dose. Our aim was an assessment of the diagnostic value of 3D angiography for visualization of cerebrovascular pathologies.
MATERIALS AND METHODS
3D-DSA data sets of cerebral aneurysms ( = 10), AVMs ( = 10), and dural arteriovenous fistulas (dAVFs) ( = 10) were reconstructed using both conventional and prototype software. Corresponding reconstructions have been analyzed by 2 neuroradiologists in a consensus reading in terms of image quality, injection vessel diameters (vessel diameter [VD] 1/2), vessel geometry index (VGI = VD1/VD2), and specific qualitative/quantitative parameters of AVMs (eg, location, nidus size, feeder, associated aneurysms, drainage, Spetzler-Martin score), dAVFs (eg, fistulous point, main feeder, diameter of the main feeder, drainage), and cerebral aneurysms (location, neck, size).
RESULTS
In total, 60 volumes have been successfully reconstructed with equivalent image quality. The specific qualitative/quantitative assessment of 3D angiography revealed nearly complete accordance with 3D-DSA in AVMs (eg, mean nidus size= 19.9 [SD, 10.9]/20.2 [SD, 11.2] mm; = 0.9, = .001), dAVFs (eg, mean diameter of the main feeder= 2.04 [SD, 0.65]/2.05 [SD, 0.63] mm; = 0.9, = .001), and cerebral aneurysms (eg, mean size= 5.17 [SD, 3.4]/5.12 [SD, 3.3] mm; = 0.9, = .001). Assessment of the geometry of the injection vessel in 3D angiography data sets did not differ significantly from that of 3D-DSA (vessel geometry index: = 0.84, = .003; vessel geometry index: = 0.82, = .003; vessel geometry index: = 0.84, <.001).
CONCLUSIONS
In this study, the artificial intelligence-based 3D angiography was a reliable method for visualization of complex cerebrovascular pathologies and showed results comparable with those of 3D-DSA. Thus, 3D angiography is a promising postprocessing method that provides a significant reduction of the patient radiation dose.
Topics: Angiography, Digital Subtraction; Artificial Intelligence; Central Nervous System Vascular Malformations; Cerebral Angiography; Humans; Imaging, Three-Dimensional; Intracranial Aneurysm; Intracranial Arteriovenous Malformations; Magnetic Resonance Angiography
PubMed: 34503946
DOI: 10.3174/ajnr.A7252 -
Sichuan Da Xue Xue Bao. Yi Xue Ban =... May 2022To evaluate the safety and effectiveness of transcatheter arterial embolization (TAE) in the treatment of acute non-variceal upper gastrointestinal bleeding (ANVUGIB),...
OBJECTIVE
To evaluate the safety and effectiveness of transcatheter arterial embolization (TAE) in the treatment of acute non-variceal upper gastrointestinal bleeding (ANVUGIB), and to guide clinical practice and continue to optimize diagnosis and treatment strategies.
METHODS
This retrospective study included 266 patients who underwent angiography due to ANVUGIB between March 2016 and March 2021. Data on the positive rate of angiography, the technical success rate and clinical success rate of TAE, and the rebleeding rate and the all-cause mortality within 30 days after TAE treatment were collected, and the influencing factors relevant to the above events were analyzed accordingly.
RESULTS
All 266 patients completed angiography--the positive rate of angiography was 54.1% (144/266), the total technical success rate was 97.3% (217/223), the clinical success rate was 73.1% (155/212), and the rebleeding rate and all-cause mortality within 30 days were 26.9% (57/212) and 16.1% (35/217), respectively. This study found that shock index>1 ( =5.950; 95% : 1.481-23.895; =0.012), computed tomography angiography (CTA) positive result ( =6.813; 95% : 1.643-28.252; =0.008) and interval<24 h ( =10.530; 95% : 2.845-38.976; <0.001) were independent predictors of positive angiography. Shock index>1 ( =2.544; 95% : 1.301-4.972; =0.006) and INR>1.5 ( =3.207; 95% : 1.381-7.451; =0.007) were independent risk factors for rebleeding. Patients with postoperative bleeding ( =3.174; 95% : 1.164-8.654; =0.024) and patients with rebleeding after embolization ( =34.665; 95% : 11.471-104.758; <0.001) had a higher risk of death within 30 days.
CONCLUSION
TAE is safe and effective in the treatment of ANVUGIB. Patients with shock index>1 and positive CTA are more likely to be angiographic positive, and should undergo angiography as early as possible after bleeding. In addition, rebleeding after embolization deserves high attention.
Topics: Acute Disease; Angiography; Embolization, Therapeutic; Gastrointestinal Hemorrhage; Humans; Retrospective Studies; Treatment Outcome
PubMed: 35642145
DOI: 10.12182/20220560203