Prophylaxis of restenosis with (186)re-labeled stents in a rabbit model.

BACKGROUND: Intraluminal beta-irradiation has been shown to decrease neointimal proliferation after angioplasty in experimental models. The purpose of this study was to test the technical feasibility and biological effects of (186)Re-labeled stents. METHODS AND RESULTS: Thirty-four New Zealand White rabbits were fed a 0.5% cholesterol diet before balloon angioplasty and insertion of Palmaz stents in the infrarenal aorta. The animals were killed 7 weeks after stent implantation. Two of 34 animals died prematurely (aortic leak, pneumonia). Control stents (n=7) were compared with (186)Re stents (2.6 MBq [n=6], 8.1 MBq [n=5], 16.0 MBq [n=6], and 25.3 MBq [n=8]). Stent application was successful in all cases. No thrombus occlusion was observed. After 7 weeks, neointima formation was 2.2+/-0.2 mm(2) in the control group. In the treatment groups, a dose-dependent neointima reduction was detectable (0.5+/-0.5 mm(2) [2.6 MBq], 0.4+/-0.4 mm(2) [8.1 MBq], and 0 mm(2) [16.0 MBq, 25.3 MBq]). No induction of neointimal formation was observed at the edges of the stents. Radiation resulted in delayed reendothelialization. CONCLUSIONS: (186)Re stents were capable of reducing neointima formation in a dose-dependent fashion. (186)Re stents did not cause late thrombosis or neointimal induction at the stent margins in the observation period of 7 weeks.

Massive pulmonary embolism: percutaneous emergency treatment by pigtail rotation catheter.

OBJECTIVES: This study was designed to assess the feasibility, efficacy and safety of mechanical fragmentation of pulmonary emboli using a new rotational pigtail catheter system. BACKGROUND: Acute massive pulmonary embolism associated with right ventricular dysfunction is frequently lethal, despite high-dose thrombolytic therapy. Adjunctive catheter fragmentation may prevent a fatal outcome. METHODS: In 20 patients (age 58.9+/-10.5 years) with severe hemodynamic impairment, massive pulmonary emboli were fragmented by mechanical action of the rotating pigtail. Fifteen patients received thrombolysis after embolus fragmentation or no thrombolysis at all (noninterference group). RESULTS: Prefragmentation pulmonary arterial occlusion was 68.6 +/- 11.3% for both lungs. Pulmonary placement and navigation of the fragmentation catheter was easy and rapid. Fragmentation time was 17+/-8 min. The noninterference group showed a decrease pre- to postfragmentation of shock index from 1.28+/-0.53 to 0.95+/-0.38 (p = 0.011), mean pulmonary artery pressure from 31+/-5.7 to 28+/-7.5 mm Hg (p = 0.02) and a recanalization by fragmentation of 32.9+/-11.8% (mean angiographic score per treated lung from 7.4 to 5.0). Overall mortality was 20%. CONCLUSIONS: Fragmentation by pigtail rotation catheter provided for a rapid and safe improvement of the hemodynamic situation and an average recanalization of about one-third of the pulmonary embolic occlusion. The method appears useful especially in high-risk patients threatened by right ventricular failure, to accelerate thrombolysis, and as a minimal-invasive alternative to surgical embolectomy.

Drug coated stents for carotid intervention.

Carotid endarterectomy has demonstrated its superiority over medical treatment of symptomatic as well as asymptomatic stenosis of the extracranial carotid artery. Although minimally invasive methods initially failed to produce similar results, stent implantation is becoming an alternative technique for stroke prophylaxis with technical advances, cerebral protection and careful patient selection. Even though restenosis does not seem to be a major limitation compared to coronary interventions, in-stent restenosis might occur more frequently with an increasing number of procedures performed and longer follow-up periods. Drug eluting stents have shown to attenuate this complication. Currently, no clinical data on drug eluting stents in carotid arteries are available. This article discusses the current literature on carotid artery stenting and the potential role of drug eluting stents in this field.

Tc-99m-labeled endothelin derivative for imaging of experimentally induced atherosclerosis.

OBJECTIVE: to characterize the potential of an endothelin derivative labeled with technetium-99m (Tc-99m) for the imaging of experimentally induced atherosclerosis. METHODS: neointima of different cellularity and severity of stenosis was induced in 32 rabbits by balloon denudation followed by distinct dietary regimens and drug application. Angiograms and scintigrams after injection of the Tc-99m-labeled endothelin derivative were obtained. The aorta was dissected for autoradiography, sudan-III-staining, morphometry, and immunohistology. RESULTS: the lesions induced could be detected in vivo (whole body scintigram) in all the animals 15 min after the injection of the Tc-99m endothelin derivative. Autoradiography revealed a strong relationship between tracer accumulation and sudan-III-staining of lesions. Accumulation of the endothelin derivative correlated with the number of neointimal smooth muscle cells (SMC), but not with the number of medial SMC, neointimal macrophages, and neointimal area. CONCLUSIONS: the results indicate that in vivo imaging of atherosclerosis with an endothelin derivative is a feasible method of detecting and characterizing atherosclerotic arterial wall lesions at early stages.

Rhenium-188 for inhibition of human aortic smooth muscle cell proliferation.

PURPOSE: To evaluate dose-dependent growth-modulating effects of the beta-gamma emitter Rhenium-188 on cultured human aortic smooth muscle cells (haSMC). METHODS AND MATERIALS: HaSMC were plated in 25 cm(2) flasks. Two days after plating, cells were incubated with the Re-188 (beta E(max) 2.12 MeV, tissue range(max) < 10 mm, T(1/2) 17 h) for five days. The doses administered were 0.2 Gy, 1, 4, 6, 8, 16, and 32 Gy. After five days, the radionuclide was removed. Cell growth, cell cycle distribution, and clonogenic activity were analyzed for the following 25 days. RESULTS: The 0.2 and 1 Gy groups did not show relevant growth-inhibiting effects compared to the control groups. The 4 to 32 Gy groups presented dose-dependent growth inhibition, with a complete growth arrest of the 16 and 32 Gy groups. Clonogenic activity of the smooth muscle cell was strongly inhibited from doses > or =8 Gy. Flow cytometry showed a lasting dose-dependent G2/M phase block. CONCLUSION: Smooth muscle cell (SMC) growth can be controlled effectively with Re-188 for at least 25 days after radiation in vitro. As the first four weeks after arterial angioplasty are crucial concerning neointimal formation, Re-188 may be a valuable radionuclide to inhibit restenosis after arterial angioplasty.

Noninvasive procedures for diagnosis of renovascular hypertension in renal transplant recipients--a prospective analysis.

The purpose of this study was to clarify the selectivity and specificity of noninvasive procedures for diagnosis of clinically suspected posttransplant renovascular hypertension. We prospectively investigated 25 renal transplant recipients with arterial hypertension and clinically suspected stenosis of the graft artery (8 female and 17 male patients; ages 45 +/- 15 years). We performed a captopril test with 25 mg captopril (n = 25), renography with technetium-99m diethylene triamine penta-acetic acid (99mTc-DTPA) before and after angiotensin-converting enzyme (ACE) inhibition with determination of glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) (n = 23) and color-coded duplex ultrasonography of the transplant kidney vessels (n = 24). Renal transplant artery stenosis (RTAS) was excluded by renal arteriography in 20 patients and by operative evaluation or clinical follow-up in 5 patients. We identified 4 patients with RTAS and renovascular hypertension. The noninvasive methods showed the following results (sensitivity/specificity): (1) captopril test: 75%/67%; (2) renography combined with ACE-inhibition: 75%/84%; and (3) color-coded duplex ultrasonography: 100%/75%. We conclude that in patients with clinical evidence of RTAS most noninvasive diagnostic procedures are not sufficiently accurate to exclude the diagnosis. Only color-coded duplex ultrasonography did not fail to detect all patients with RTAS and may act as a screening test. Intraarterial renal angiography remains the most reliable and as-yet indispensable diagnostic test for transplant recipients to rule out RTAS.

Molecular imaging of atherosclerosis using a technetium-99m-labeled endothelin derivative.

UNLABELLED: Endothelins have been implicated in the pathogenesis of atherosclerosis and restenosis. The aim of this study was to characterize the potential of an endothelin derivative labeled with 99mTc for imaging experimental atherosclerosis in vivo. METHODS: Atherosclerosis was induced by balloon denudation of the infrarenal aorta in eight New Zealand white rabbits followed by a 6-wk period of a standard or 0.5% cholesterol diet in four animals, respectively. Another four rabbits served as controls, without balloon denudation and cholesterol feeding. Digital subtraction angiograms and planar whole-body scintigrams were obtained after intravenous injection of 74 MBq of the 99mTc-labeled endothelin derivative. The aorta was dissected for autoradiography, sudan-III staining, morphometry and immunohistology (anti-alpha-actin, RAM 11) 5 hr after injection. RESULTS: The lesions induced in the infrarenal aorta could be detected in vivo (whole-body scintigrams) in all treated animals only 15 min after injection of 99mTc-endothelin derivative. Autoradiography of the excised aorta revealed good correlation of tracer accumulation and sudan-III-stained lesions. The ratio of accumulation between the induced lesions and untreated vessel wall was 6.8 +/- 1.4 in the cholesterol-fed animals and 6.3 +/- 1.8 in the animals without cholesterol feeding. Accumulation of the endothelin derivative correlated with the number of smooth muscle cells (r = 0.924) but not with the amount of macrophages, the area or the maximum thickness of the plaques. CONCLUSION: Scintigraphic visualization of experimentally induced atherosclerosis in vivo is feasible using an endothelin derivative labeled with 99mTc.

Ablation characteristics of arterial vessel walls irradiated with the pulsed dye laser--an analysis of variance.

BACKGROUND AND OBJECTIVE: Since most clinical laser angioplasties require the use of over-the-wire delivery systems, we studied the effects of pulsed dye laser energy (504 nm, 1.4 microseconds on arterial vessel walls in combination with a multifiber catheter system. MATERIAL AND METHODS: Postmortem arterial segments (n = 368) were exposed under blood or saline. Laser pulses (n = 100-800) were transmitted via 9F-multifiber-catheters, at energy densities of 3-16 J/cm2. Ablation characteristics revealed by histologic examination and morphometry were analyzed by multiple analysis of variance. RESULTS: Ablation occurred more frequently in saline compared to blood. Below an energy density of 10 J/cm2 ablation occurred in saline only. Specimens irradiated under blood showed only thermal changes at 10 J/cm2. In saline, 92% of normal, 88% of fibro-fatty and 60% of calcified tissue showed ablation at 13 J/cm2. The average ablation threshold in saline was about 3-4 J/cm2 per pulse for normal tissue, 5 J/cm2 for fatty plaques, and 8-9 J/cm2 for calcified plaques. In blood, the average ablation thresholds did not differ significantly between the different stages of arteriosclerosis (12 J/cm2 for normal tissue, 11 J/cm2 for fatty plaque, and 10 J/cm2 for calcified tissue). Carbonization and vacuolization were seen regularly at energy levels > or = 13.4 J/cm2. CONCLUSIONS: Selective ablation of arteriosclerotic tissue with the pulsed dye laser could not be found. Further investigation is needed before an effective ablation of arteriosclerotic arterial tissue can be expected.

Comparison of magnetic resonance imaging methods for examinations of abdominal aortic aneurysms.

RATIONALE AND OBJECTIVES: Different magnetic resonance imaging techniques were compared with respect to available anatomic information regarding abdominal aortic aneurysms (AAA) and regions involved in thrombosis. METHODS: Twenty patients with AAA were examined by turbo spin-echo (TSE) imaging of coronal and transverse slices, resulting in black blood images. Bright blood imaging was performed using a spoiled gradient-echo sequence with gradient moment nulling. Sets of 25 to 50 thin slices were recorded sequentially in a single slice mode using coronal and transverse orientation. Both sets of bright blood images were reconstructed by maximum intensity projection. RESULTS: In all patients, the size and shape of the AAA could better be assessed by the TSE images than by the gradient-echo images. In contrast, reliable differentiation of thrombotic areas and of the perfused lumen was possible in only 56% of the slices recorded by TSE imaging but in 94% of the gradient-echo images. The two-dimensional inflow technique provided clearly higher sensitivity even to slow blood flow than TSE imaging. Maximum intensity projection reconstructions from sets of coronal two-dimensional inflow images often did not depict the lower part of the AAA because of saturation effects, whereas sets of transverse slices provided complete angiograms of the aortoiliac vascular tree. DISCUSSION: At this time, no single magnetic resonance method can provide all essential information. A comprehensive examination should include TSE imaging for topographic assessment and transverse two-dimensional inflow imaging for analysis of thrombotic areas.

Covered stents for prevention of restenosis. Experimental and clinical results with different stent designs.

RATIONALE AND OBJECTIVES: Metallic stents in small vessels go along with a significant risk of restenosis and reocclusion. Different models of stents and covering materials have been purported to prevent intraluminal neointimal proliferation by cover-based closure of the spaces in the wire mesh. METHODS: Tantalum stents covered with polyethylacrylate/polymethylmethacrylate (PEM) were implanted in the infrarenal aorta of six New Zealand white rabbits by aortotomy and compared with eight rabbits treated with uncovered tantalum stents. For deployment, covered and uncovered stents necessitated a 7-French (F) and 5-F sheath, respectively. In addition, nine human patients with arteriosclerotic lesions of the superficial femoral arteries (stenosis > 5 cm or total occlusion) were treated percutaneously with a Dacron-covered nitinol vascular stent via a 9-F sheath. Patients were followed for a mean of 13.5 months, and control angiography was performed after 6 months. RESULTS: Experimental placement of the tantalum Wiktor stent was feasible technically in all cases. Five of six stents covered with PEM were occluded 3 days after placement despite the intravenous use of heparin and aspirin. In the group with uncovered stents, no area of stenosis greater than 10% was observed. There was a neointimal layer of 89 +/- 68 microns around the stent wires. Stent placement was successful in all patients. In four patients, a hyperergic reaction occurred, resulting in noninfectious periarteriitis. This complication was treated successfully with nonsteroidal antiinflammatory drugs. The primary patency was 50%, and the secondary patency (after application of a second covered stent in two patients) was 63%. CONCLUSIONS: The uncovered stent induces little neointimal proliferation around the stent wires. The insertion of stents covered with PEM into the rabbit aorta was accompanied by a strong thrombotic reaction, despite sufficient anticoagulation. Dacron-covered nitinol stents showed a surprisingly high restenosis rate after 9 months of follow-up. Further research concerning the in vivo properties of new covering materials is mandatory before routine vascular clinical application.

Local intra-arterial drug delivery for prevention of restenosis: comparison of the efficiency of delivery of different radiopharmaceuticals through a porous catheter.

RATIONALE AND OBJECTIVES: Several radiopharmaceuticals were administered through a porous balloon catheter to compare the absolute amount deposited and the retention in the vessel wall. The reported efficiency of local drug delivery ranges from 0.001% to 0.1%, with poor retention after 24 hours. METHODS: An endothelin derivative (n = 6), pertechnetate (n = 6), hexamethylpropylene amineoxime (HMPAO) (n = 5), ethyl cysteinate dimer (ECD) (n = 5), and tin colloid (n = 5) were labeled with 185 MBq/mL 99m-technetium. After balloon denudation of the infrarenal aorta in 27 New Zealand White rabbits, 100 microL of each agent was administered through a porous balloon at a pressure of 4 bar. Dynamic and static whole-body scintigrams were obtained for 24 hours. The infrarenal aorta was excised and the activity calculated in a gamma counter. RESULTS: Apart from their retention in the region of local administration, the radiopharmaceuticals showed different distribution patterns. The highest regional tracer retention was observed with HMPAO. After administration of HMPAO, a significant difference between regional (vessel wall plus surrounding tissue: 14.5% of injected dose [ID]/24 hours) and local (vessel wall: 1.8% ID/24 hours) delivery was found. In contrast, ECD was eliminated quickly (local retention after 24 hours = 0% ID). The retention efficiencies were HMPAO > endothelin derivative > tin colloid > pertechnetate > ECD. CONCLUSIONS: The different physicochemical and pharmacokinetic properties of radiopharmaceuticals resulted in different delivery efficiencies after local application.

Lipids in bone tumors assessed by magnetic resonance: chemical shift imaging and proton spectroscopy in vivo.

The methods of fat and water selective magnetic resonance (MR) imaging and localized 1H MR spectroscopy were evaluated in the course of 37 examinations on 27 primary bone tumors. These methods are capable of demonstrating small amounts of lipids inside the tumors and subtle edema in the adacent bone marrow, in contrast to the usually applied spin-echo and gradient-echo sequences providing signals dependent on the total proton density and on the relaxation times. The tumor masses of the malignant tumors were free of signals in the fat selective images, whereas in three out of six osteochondroma fat signals could be detected. Localized MR spectroscopy was more sensitive even to very low lipid content (lipid portion < 0.5%) in the tumors and revealed signals with J-coupling from seven out of 13 malignant tumors.

Gd-enhanced 3D phase-contrast MR angiography and dynamic perfusion imaging in the diagnosis of renal artery stenosis.

The objective of this study was to investigate the role of contrast enhancement using a three-dimensional (3D) phase-contrast (PC) magnetic resonance (MR) sequence (3D PC-MRA) and to assess the value of a dynamic MR perfusion study of the kidneys to determine the hemodynamic relevance of unilateral renal artery stenosis (RAS). Seventeen patients with unilateral RAS were examined on a standard 1.0 T imaging system using a phase shift and magnitude sensitive 3D PC sequence (TR=160 ms, TE=9 ms, venc. 30 cm/s). Following the initial pre-contrast 3D PC-MRA a dynamic first pass perfusion study was performed using a Turbo-FLASH 2D sequence (TR=4.5 ms, TE=2.2 ms, TI=400 ms) after bolus injection of 0.15 mmol gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA)/kg body weight. The 3D PC-MRA was then repeated during infusion of 0.15 mmol Gd-DTPA/kg body weight. Evaluation by three independent readers was based on maximum intensity projection images. Source images were rendered on request. Signal intensity (SI) over time curves of the renal cortex were obtained from the dynamic perfusion study and analyzed for maximum signal enhancement as well as temporal relationship to the aortic SI curve. Results from 3D PC-MRA revealed a sensitivity (pre-/post-contrast) of 100%/89%, specificity of 76%/63%, positive predictive value of 80%/69 %, negative predictive value of 90%/78%, and accuracy of 85%/75% (p=0.07). Interobserver agreement was kappa=0.61/kappa=0.47 (pre/post Gd-DTPA), respectively. Increased signal-to-noise was present in all segments of the renal arteries post contrast (p=0.0003). This came along with image degradation due to aliasing and elevated SI of venous flow that partially obscured the renal arteries. Dynamic SI curves showed a significantly decreased maximum SI in RAS (p=0.01-0.001). A temporal delay of cortical signal intensity enhancement could not be confirmed in this setting. Gd-enhanced 3D PC-MRA did not yield a superior diagnostic value in the diagnosis of RAS compared to pre-contrast measurements. Dynamic perfusion imaging of the kidneys, in combination with 3D PC-MRA, can contribute additional information in suspected unilateral RAS.

New strategies in platelet inhibition in noncoronary interventions.

Thrombembolic complications frequently occur during and after endovascular procedures because of associated arterial injury and thrombotic characteristics of implanted devices such as stents. New strategies in platelet aggregation inhibition are now available blocking the final and common pathway of platelet aggregation, the glycoprotein IIb/IIIa receptor. This treatment modality seems to be more effective for prophylaxis and prevention of thrombembolic complications than standard antiplatelet therapy. Most of the data provided for glycoprotein IIb/IIIa receptor blockade are derived from studies of coronary interventions. This report reviews the pharmacodynamic differences of classic and new drugs for platelet inhibition and the basic considerations for antiplatelet therapy in noncoronary interventions.

The double-line sign of osteonecrosis: evaluation on chemical shift MR images.

The MR appearance of osteonecrosis was assessed on selective fat and water images to further evaluate the features of the double-line sign of osteonecrosis. Conventional T1- and T2-weighted spin-echo and frequency selective chemical shift images of eight patients with avascular necrosis of the femoral head and three patients with bone infarcts were retrospectively reviewed. Eight of 11 patients showed a double-line sign on T2-weighted spin-echo images. In these cases correlation with selective water images revealed that a chemical shift artifact contributed to the appearance and location of the hyperintense line. The double-line sign was not seen in three patients with radiologically and clinically proven osteonecrosis. It is concluded that chemical shift imaging improves our understanding of the nature of the double-line sign.

Posttransplant renal artery stenosis--outpatient intraarterial DSA versus color aided duplex Doppler sonography.

A prospective trial was conducted to assess the accuracy of color aided duplex Doppler (CADD) sonography to rule out transplant renal artery stenosis (TRAS) and to determine feasibility and safety of intraarterial digital subtraction angiography (DSA) in hypertensive renal allograft recipients on an outpatient basis. All patients were hypertensive (n = 18, mean age: 42 +/- 11 years) and underwent CADD and an i.a. DSA with 4F catheters. There was a 4 hour rest post DSA. Duplex Doppler measurements of maximum velocity were obtained. Absolute values of > or = 100 cm/s were considered indicative to suspect TRAS. DSA revealed severe TRAS in 4 patients (22%). The stenoses were located near the iliorenal anastomosis (n = 2) and at the bifurcation of the renal artery (n = 2). Duplex Doppler classified twelve (67%) renal artery pedicles normal (maximum velocity: 79 +/- 23 cm/s). TRAS was suspected in 6 patients with a maximum velocity of 159 +/- 48 cm/s (P < 0.01). False positive CADD diagnoses were due to tortuous graft vessels and a postbiopsy arteriovenous fistula. Sensitivity of CADD was 100%, specificity 86%. There were no DSA related complications. No impairment of graft function occurred. CADD allows renal angiography to be reserved to clarify an inconclusive ultrasound study and for definite diagnosis of angiomorphology and lesion classification. Intraarterial DSA of renal grafts in outpatients may be performed without an increased risk of procedure-related complications.

[The physician's duty to inform in interventional radiological therapeutic procedures]. / Die ärztliche Aufklärungspflicht bei interventionell-radiologischen Therapieverfahren.

PURPOSE: Interventional radiological procedures have important legal implications. The importance of informing the patient ("informed consent") before such procedures is examined in the light of German legal cases. MATERIAL AND METHODS: The German legal literature is reviewed and recent judgments of the Courts are cited. RESULTS: No all-embracing rules can be obtained from the judgments of the German Courts. Mostly one is dealing with individual judgments which can help in a general sense. The patient should be informed well before elective invasive procedures ("informed consent") and the amount of detailed information which is requested to be given to the patient appears to be increasing. Reversal of this trend in the future is unlikely. DISCUSSION: These judgments are of immediate significance for any radiologist who carries out interventional radiological procedures. In the case of complicated techniques the patient should be informed at the time of admission and a definite date for the procedure should be set. Explanations given on the evening before the procedure are deemed to be too late, unless there are exceptional circumstances. Where new forms of therapy are attempted, the information should be even more detailed. In particular it is necessary to stress the experimental nature of the procedure.

[Determination of hematocrit and iodine concentrations following intravenous bolus administration of ionic and nonionic monomeric and dimeric contrast media--an animal experimental study]. / Hämatokrit- und Jodkonzentrationsbestimmungen nach intravenöser Bolusapplikation ionischer und nichtionischer monomerer und dimerer Kontrastmittel--Tierexperimentelle Studie.

A monomeric ionic (meglumine diatrizoate), a monomeric non-ionic (iopromide) and a dimeric non-ionic contrast medium were intravenously administered (V. jugularis) to 15 rabbits. Blood iodine concentration as well as haematocrit were determined from blood samples taken from the femoral artery immediately after injection until the 90th second p.i. The contrast media showed clear differences concerning the haematocrit, i.e. the isotonic non-ionic dimer induced its lowest decrease. The direct determination of the blood iodine concentration revealed no significant deviations between the contrast media studied. Only non-ionic dimers are iso-osmolar with plasma at the iodine concentrations employed in diagnostic radiology. Compared with monomeric compounds this study provides fundamental evidence that isotonic, non-ionic dimeric contrast media cause only slight effects on blood cells. This confirms experimentally the clinically reported good tolerance of dimeric contrast media in patients.

[Contrast-enhanced MR cholangiography in percutaneous bile duct drainage]. / Kontrastverstärkte MR-Cholangiographie bei perkutaner Gallenwegsdrainage.

PURPOSE: To evaluate MR-cholangiography after instillation of contrast media via indwelling biliary tubes. METHODS: In 8 patients with stenoses of the central bile ducts, physiological saline solution and diluted contrast media (Gd-DTPA, 5 mmol/l) were consecutively administered via an indwelling biliary tube. MR cholangiograms were obtained before and after saline injection using a HASTE-sequence and after administration of Gd-DTPA using a T1-weighted gradient echo sequence. RESULTS: Peripheral bile ducts were better visualised in the water-sensitive approach than after Gd-DTPA enhancement. In patients with short-time drainage bile duct definition was poor due to periportal oedema. Visualisation of peripheral bile ducts could be improved by injection of saline solution in these patients. After administration of Gd-DTPA via the biliary tube contrast enhancement of the central bile ducts was achieved in all patients except for one patient on long-term drainage with an indwelling Yamakawa tube. CONCLUSION: T1-weighted visualisation of the central bile ducts can be achieved by means of injection of Gd-DTPA via indwelling biliary tubes.

[The adjuvant use of the monoclonal antibody c7E3 Fab in peripheral arterial thrombolysis]. / Adjuvanter Einsatz des monoklonalen Antikörpers c7E3 Fab bei peripherer arterieller Thrombolyse.

Thrombolysis of arterial occlusions has limitations, e.g. it requires extensive time for thrombolysis, occlusions may be resistant to lysis, and the rate of reocclusions may be high. c7E3 Fab inhibits platelet aggregation by binding to the GPIIb/IIIa receptor on platelets. Experimentally, this monoclonal antibody has been shown to decrease, the time required for lysis, and to prevent reocclusion. This is the first report on the adjunctive use of c7E3 Fab in peripheral arterial occlusions in humans. Three patients with occlusion of the iliac or femoropopliteal artery were treated with c7E3 Fab (bolus injection of 0.25 mg/kg KG + i.v.-application 12 micrograms/min for 12 h). In addition, the patients received urokinase (100,000 IU bolus + 100,000 IU/h). Heparin (5,000 IU bolus + 1,000 IU/h) and acetylsalicylate (100 mg/day/p.o.). Occlusion length ranged between 6-40 cm. Therapy was successful in all patients. During the follow-up period (4-6 months) no reocclusion occurred. There were no serious side effects like major bleeding or thrombocytopenia. We conclude that the applied doses appear safe. Even the time required for thrombolysis was short, a conclusion in respect of a significant reduction of the time required for lysis can be drawn only after further controlled studies.