RESUMEN
Virtual mono-energetic images (VMI) using dual-layer computed tomography (DLCT) enable substantial contrast medium (CM) reductions. However, the combined impact of patient size, tube voltage, and heart rate (HR) on VMI of coronary CT angiography (CCTA) remains unknown. This phantom study aimed to assess VMI levels achieving comparable contrast-to-noise ratio (CNR) in CCTA at 50% CM dose across varying tube voltages, patient sizes, and HR, compared to the reference protocol (100% CM dose, conventional at 120 kVp). A 5 mm artificial coronary artery with 100% (400 HU) and 50% (200 HU) iodine CM-dose was positioned centrally in an anthropomorphic thorax phantom. Horizontal coronary movement was matched to HR (at 0, < 60, 60-75, > 75 bpm), with varying patient sizes simulated using phantom extension rings. Raw data was acquired using a clinical CCTA protocol at 120 and 140 kVp (five repetitions). VMI images (40-70 keV, 5 keV steps) were then reconstructed; non-overlapping 95% CNR confidence intervals indicated significant differences from the reference. Higher CM-dose, reduced VMI, slower HR, higher tube voltage, and smaller patient sizes demonstrated a trend of higher CNR. Regardless of HR, patient size, and tube voltage, no significant CNR differences were found compared to the reference, with 100% CM dose at 60 keV, or 50% CM dose at 40 keV. DLCT reconstructions at 40 keV from 120 to 140 kVp acquisitions facilitate 50% CM dose reduction for various patient sizes and HR with equivalent CNR to conventional CCTA at 100% CM dose, although clinical validation is needed.
Asunto(s)
Angiografía por Tomografía Computarizada , Medios de Contraste , Angiografía Coronaria , Vasos Coronarios , Frecuencia Cardíaca , Fantasmas de Imagen , Valor Predictivo de las Pruebas , Dosis de Radiación , Humanos , Angiografía Coronaria/instrumentación , Angiografía Coronaria/métodos , Angiografía por Tomografía Computarizada/instrumentación , Medios de Contraste/administración & dosificación , Vasos Coronarios/diagnóstico por imagen , Exposición a la Radiación/prevención & control , Interpretación de Imagen Radiográfica Asistida por Computador , Tamaño CorporalRESUMEN
Abstract The aim of our study was to assess risk factors for potential drug-drug interactions (pDDIs) of statins across different phases of treatment of acute coronary syndrome (ACS) patients: from the point of first medical contact to the coronary angiography (first phase), after coronary angiography to the last day of hospitalization (second phase) and at discharge from hospital (third phase). This was a post hoc analysis of the data collected during the retrospective observational cohort study conducted at the Clinic for Cardiology of the Clinical Centre Kragujevac, Serbia. Patients prescribed statins were identified from the original study population: 156, 240 and 236 patients for the first, second and third phases, respectively. At least one statin pDDI was present in 113 (72.4%), 161 (67.1%) and 139 (58.9%) patients in the first, second and third phases, respectively. Heart failure, arrhythmias after ACS, CRP, triglycerides, length of hospitalization, number of prescribed drugs, antiarrhythmic drugs, and clopidogrel seem to increase the risk of statin pDDIs in at least one treatment phase. Physicians should be vigilant to the possibility of statin pDDIs in ACS patients who have factors that may increase their rate.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Pacientes/clasificación , Factores de Riesgo , Inhibidores de Hidroximetilglutaril-CoA Reductasas/efectos adversos , Interacciones Farmacológicas , Síndrome Coronario Agudo/patología , Preparaciones Farmacéuticas/administración & dosificación , Cardiología/clasificación , Angiografía Coronaria/instrumentación , Serbia , ClopidogrelRESUMEN
OBJECTIVE: We sought to compare the angiographic and clinical outcomes of drug-coated balloon (DCB) with distal embolic protection devices (EPDs) versus bare metal stent (BMS) without EPD in the treatment of symptomatic vertebral artery origin stenosis (VAOS). METHODS: Between January 2017 and December 2018, a prospective randomized trial was conducted involving 95 patients with symptomatic VAOS randomly assigned to treatment with DCB + EPD (n = 49) or BMS without EPD (n = 46). Target vessel restenosis (RS) >50% detected by computed tomography angiography was the primary endpoint. Technical success, clinical success, and signal intensity abnormalities on diffusion-weighted imaging within 3 days after operation were compared. RESULTS: The 30-day technical success rate was 93.9% for DCB group versus 95.7% for the BMS group (P = 0.094). Diffusion-weighted imaging within 3 days postoperative showed asymptomatic embolization in 2 (4.1%) patients in the DCB group and 9 (19.6%) patients in the BMS group (P = 0.004). At a mean 16-month follow-up, the clinical success rate was 89.8% for the DCB group versus 91.3% (42/46) for the BMS group (P = 0.125). The RS was seen in 5/49 (10.2%) in the DCB group and 6/46 (13.0%) in the BMS group (P = 0.082). Target vessel revascularization was performed in 4 (8.7%) BMS group versus 3 (6.1%) in the DCB group (P = 0.091). CONCLUSIONS: DCB with EPD in the treatment of symptomatic VAOS is technically feasible and safe and significantly reduced thromboembolic events on imaging when compared with BMS without EPD. There was no significant difference between the 2 groups in the rate of RS during 12 months after surgery.
Asunto(s)
Angiografía Coronaria/instrumentación , Angiografía Coronaria/métodos , Stents , Insuficiencia Vertebrobasilar/cirugía , Anciano , Clopidogrel/administración & dosificación , Sistemas de Liberación de Medicamentos/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Inhibidores de Agregación Plaquetaria/administración & dosificación , Estudios Prospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: Intraoperative coronary angiography can tremendously reduce early coronary bypass graft failures. Fluorescent cardiac imaging provides an advanced method for intraoperative observation and real-time quantitation of blood flow with high resolution. METHODS: We devised a system comprised of an LED light source, special filters, lenses and a detector for preclinical coronary artery angiography. The optical setup was implemented by using two achromatic doublet lenses, two positive meniscus lenses, a band-pass filter, a pinhole and a CCD sensor. The setup was optimized by Zemax software. Optical design was further challenged to obtain more parallel light beams, less diffusion and higher resolutions to levels as small as arterioles. Ex vivo rat hearts were prepared and coronary arteries were retrogradely perfused by indocyanine green (ICG). Video angiography was employed to assess blood flow and plot time-dependent fluorescence intensity curve (TIC). Quantitation of blood flow was performed by calculating either the gradient of TIC or area under curve. The correlation between blood flow and each calculated parameters was assessed and used to evaluate the quality of flow. RESULTS: High-resolution images of flow in coronary arteries were obtained as precise as 62 µm vessel diameter, by our custom-made ICG angiography system. The gradient of TIC was 3.4-6.3 s-1, while the area under curve indicated 712-1282 s values which ultimately gained correlation coefficients of 0.9938 and 0.9951 with relative blood flow, respectively. CONCLUSION: The present ICG angiography system may facilitate evaluation of blood flow in animal studies of myocardial infarction and coronary artery grafts intraoperatively.
Asunto(s)
Angiografía Coronaria/instrumentación , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Vasos Coronarios/diagnóstico por imagen , Angiografía con Fluoresceína/instrumentación , Animales , Angiografía Coronaria/métodos , Circulación Coronaria , Humanos , Cuidados Preoperatorios/instrumentación , RatasRESUMEN
INTRODUCTION: With increasing adoption of CT coronary angiography (CTA) there is increasing demand for cost-effective, small footprint, dedicated cardiac scanners. We compared a state-of-the-art, small footprint dedicated cardiac scanner (DCCT) to a standard multidetector scanner (MDCT). METHODS: The study was a retrospective unblinded single centre study. A total of 800 patients were included, with 400 undergoing a DCCT and MDCT coronary CTA scanning, respectively. Image quality was assessed using a 4-point grading score. Image noise and artifact, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR), and acceptance rate for CT-derived fractional flow reserve (FFRct) were recorded. RESULTS: Overall image quality was higher in the DCCT group (3.8 ± 0.55 vs 3.6 ± 0.69; p = 0.042). There was no difference in overall image noise (p = 0.131) or artifact (p = 0.295). SNR was superior in the DCCT group (14.2 ± 6.85 vs 11.4 ± 3.32; p < 0.005) as was CNR (12.7 ± 6.77 vs 11.9 ± 3.29; p < 0.005). The heart rate was lower in the DCCT group (56 ± 9.1 vs 59 ± 8.1; p < 0.005). No difference in the dose length product (DLP median 244.53 (IQR 105.6) vs 237.63 (IQR 160.1); p = 0.313) or FFRCT acceptance rate (100 vs 97.7%; p > 0.05) was noted. Independent predictors of excellent quality regardless of scanner type were age (p = 0.011), heart rate <65 bpm (p < 0.005), and body mass index < 35 (p < 0.005). CONCLUSION: A DCCT scanner is capable of image quality similar to modern current generation general purpose CT technology. Such technology appears to be a viable option to serve the increasing demand for CTCA imaging.
Asunto(s)
Angiografía Coronaria/instrumentación , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Vasos Coronarios/diagnóstico por imagen , Tomografía Computarizada Multidetector/instrumentación , Tomógrafos Computarizados por Rayos X , Tomografía Computarizada por Rayos X/instrumentación , Anciano , Enfermedad de la Arteria Coronaria/fisiopatología , Vasos Coronarios/fisiopatología , Diseño de Equipo , Femenino , Reserva del Flujo Fraccional Miocárdico , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Dosis de Radiación , Reproducibilidad de los Resultados , Estudios RetrospectivosRESUMEN
To investigate the feasibility of quantifying the chemical composition of coronary artery plaque in terms of water, lipid, protein, and calcium contents using dual-energy computed tomography (CT) in a simulation study. A CT simulation package was developed based on physical parameters of a clinical CT scanner. A digital thorax phantom was designed to simulate coronary arterial plaques in the range of 2-5 mm in diameter. Both non-calcified and calcified plaques were studied. The non-calcified plaques were simulated as a mixture of water, lipid, and protein, while the calcified plaques also contained calcium. The water, lipid, protein, and calcium compositions of the plaques were selected to be within the expected clinical range. A total of 95 plaques for each lesion size were simulated using the CT simulation package at 80 and 135 kVp. Half-value layer measurements were made to make sure the simulated dose was within the range of clinical dual energy scanning protocols. Dual-energy material decomposition using a previously developed technique was performed to determine the volumetric fraction of water, lipid, protein, and calcium contents in each plaque. For non-calcified plaque, the total volume conservation provides the third constrain for three-material decomposition with dual energy CT. For calcified plaque, a fourth criterion was introduced from a previous report suggesting a linear correlation between water and protein contents in soft tissue. For non-calcified plaque, the root mean-squared error (RMSE) of the image-based decomposition was estimated to be 0.7%, 1.5%, and 0.3% for water, lipid, and protein contents, respectively. As for the calcified plaques, the RMSE of the 5 mm plaques were estimated to be 5.6%, 5.7%, 0.2%, and 3.1%, for water, lipid, calcium, and protein contents, respectively. The RMSE increases as the plaque size reduces. The simulation results indicate that chemical composition of coronary arterial plaques can be quantified using dual-energy CT. By accurately quantifying the content of a coronary plaque lesion, our decomposition method may provide valuable insight for the assessment and stratification of coronary artery disease.
Asunto(s)
Angiografía por Tomografía Computarizada , Simulación por Computador , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Vasos Coronarios/diagnóstico por imagen , Placa Aterosclerótica , Calcio/análisis , Angiografía por Tomografía Computarizada/instrumentación , Angiografía Coronaria/instrumentación , Enfermedad de la Arteria Coronaria/patología , Vasos Coronarios/patología , Estudios de Factibilidad , Humanos , Lípidos/análisis , Fantasmas de Imagen , Valor Predictivo de las Pruebas , Proteínas/análisis , Agua/análisisRESUMEN
Background: One-catheter strategy, based in multipurpose catheters, allows exploring both coronary arteries with a single catheter. This strategy could simplify coronary catheterization and reduce the volume of contrast administration, by reducing radial spasm. To date, observational studies showed greater benefits regarding contrast consumption and catheterization performance than controlled trials. The aim of this work is to perform the first systematic review and meta-analysis of randomized clinical trials (RCT) to adequately quantify the benefits of one-catheter strategy, with multipurpose catheters, over conventional two-catheter strategy on contrast consumption, and catheterization performance. Methods: A search in PubMed, CINALH, and CENTRAL databases was conducted to identify randomized trials comparing one-catheter and two-catheter strategies. The primary outcome was volume of iodinated contrast administrated. Secondary endpoints, evaluating coronary catheterization performance included: arterial spasm, fluoroscopy time, and procedural time. Results: Five RCT were included for the final analysis, with a total of 1599 patients (802 patients with one-catheter strategy and 797 patients with two-catheter strategy). One-catheter strategy required less administration of radiological contrast (difference in means [DiM] [95% confidence interval (CI)]; -3.831 mL [-6.165 mL to -1.496 mL], p = 0.001) as compared to two-catheter strategy. Furthermore, less radial spasm (odds ratio [95% CI], 0.484 [0.363 to 0.644], p < 0.001) and less procedural time (DiM [95% CI], -72.471 s [-99.694 s to -45.249 s], p < 0.001) were observed in one-catheter strategy. No differences on fluoroscopy time were observed. Conclusions: One-catheter strategy induces a minimal reduction on radiological contrast administration but improves coronary catheterization performance by reducing arterial spasm and procedural time as compared to conventional two-catheter strategy.
Antecedentes: La estrategia de catéter único permite explorar ambas coronarias con un solo catéter. Nuestro objetivo es realizar la primera revisión sistemática y meta-análisis de ensayos clínicos aleatorizados para cuantificar adecuadamente los beneficios de la estrategia de catéter único, con catéteres multipropósito, sobre la estrategia convencional de dos catéteres. Métodos: Se realizó una búsqueda en PubMed, CINALH y CENTRAL, identificando ensayos aleatorizados que compararan estrategias de un catéter y dos catéteres. El resultado primario fue volumen de contraste administrado. Los secundarios, que evaluaron el rendimiento del cateterismo, incluyeron: espasmo radial, tiempo de fluoroscopia y de procedimiento. Resultados: Se incluyeron cinco ensayos, totalizando 1,599 pacientes (802 con estrategia de un catéter y 797 con estrategia de dos catéteres). La estrategia de catéter único requirió menos contraste (diferencia-de-medias; −3.831 mL [−6.165 mL a −1.496 mL], p = 0.001), presentando menos espasmo radial (odds ratio, 0.484 [0.363 a 0.644], p < 0.001) y menos tiempo de procedimiento (diferencia-de-medias; −72.471 s [−99.694 s a −45.249 s], p < 0.001). No hubo diferencias en el tiempo de fluoroscopia. Conclusiones: La estrategia de catéter único induce una reducción mínima en la administración de contraste, pero mejora el rendimiento del cateterismo al reducir el espasmo radial y el tiempo de procedimiento en comparación con la estrategia convencional.
Asunto(s)
Cateterismo Cardíaco/métodos , Catéteres Cardíacos , Angiografía Coronaria/métodos , Cateterismo Cardíaco/instrumentación , Medios de Contraste/administración & dosificación , Angiografía Coronaria/instrumentación , Vasos Coronarios/diagnóstico por imagen , Fluoroscopía , Humanos , Arteria Radial , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
Abstract Background: One-catheter strategy, based in multipurpose catheters, allows exploring both coronary arteries with a single catheter. This strategy could simplify coronary catheterization and reduce the volume of contrast administration, by reducing radial spasm. To date, observational studies showed greater benefits regarding contrast consumption and catheterization performance than controlled trials. The aim of this work is to perform the first systematic review and meta-analysis of randomized clinical trials (RCT) to adequately quantify the benefits of one-catheter strategy, with multipurpose catheters, over conventional two-catheter strategy on contrast consumption, and catheterization performance. Methods: A search in PubMed, CINALH, and CENTRAL databases was conducted to identify randomized trials comparing one-catheter and two-catheter strategies. The primary outcome was volume of iodinated contrast administrated. Secondary endpoints, evaluating coronary catheterization performance included: arterial spasm, fluoroscopy time, and procedural time. Results: Five RCT were included for the final analysis, with a total of 1599 patients (802 patients with one-catheter strategy and 797 patients with two-catheter strategy). One-catheter strategy required less administration of radiological contrast (difference in means [DiM] [95% confidence interval (CI)]; −3.831 mL [−6.165 mL to −1.496 mL], p = 0.001) as compared to two-catheter strategy. Furthermore, less radial spasm (odds ratio [95% CI], 0.484 [0.363 to 0.644], p < 0.001) and less procedural time (DiM [95% CI], −72.471 s [−99.694 s to −45.249 s], p < 0.001) were observed in one-catheter strategy. No differences on fluoroscopy time were observed. Conclusions: One-catheter strategy induces a minimal reduction on radiological contrast administration but improves coronary catheterization performance by reducing arterial spasm and procedural time as compared to conventional two-catheter strategy.
Resumen Antecedentes: La estrategia de catéter único permite explorar ambas coronarias con un solo catéter. Nuestro objetivo es realizar la primera revisión sistemática y meta-análisis de ensayos clínicos aleatorizados para cuantificar adecuadamente los beneficios de la estrategia de catéter único, con catéteres multipropósito, sobre la estrategia convencional de dos catéteres. Métodos: Se realizó una búsqueda en PubMed, CINALH y CENTRAL, identificando ensayos aleatorizados que compararan estrategias de un catéter y dos catéteres. El resultado primario fue volumen de contraste administrado. Los secundarios, que evaluaron el rendimiento del cateterismo, incluyeron: espasmo radial, tiempo de fluoroscopia y de procedimiento. Resultados: Se incluyeron cinco ensayos, totalizando 1,599 pacientes (802 con estrategia de un catéter y 797 con estrategia de dos catéteres). La estrategia de catéter único requirió menos contraste (diferencia-de-medias; −3.831 mL [−6.165 mL a −1.496 mL], p = 0.001), presentando menos espasmo radial (odds ratio, 0.484 [0.363 a 0.644], p < 0.001) y menos tiempo de procedimiento (diferencia-de-medias; −72.471 s [−99.694 s a −45.249 s], p < 0.001). No hubo diferencias en el tiempo de fluoroscopia. Conclusiones: La estrategia de catéter único induce una reducción mínima en la administración de contraste, pero mejora el rendimiento del cateterismo al reducir el espasmo radial y el tiempo de procedimiento en comparación con la estrategia convencional.
Asunto(s)
Humanos , Cateterismo Cardíaco/métodos , Angiografía Coronaria/métodos , Catéteres Cardíacos , Fluoroscopía , Cateterismo Cardíaco/instrumentación , Ensayos Clínicos Controlados Aleatorios como Asunto , Angiografía Coronaria/instrumentación , Arteria Radial , Medios de Contraste/administración & dosificación , Vasos Coronarios/diagnóstico por imagenRESUMEN
Coronary computed tomography angiography is an established technique in clinical practice and a valuable tool in the diagnosis of coronary artery disease in humans. Imaging of coronaries in preclinical research, i.e. in small animals, is very difficult due to the high demands on spatial and temporal resolution. Mice exhibit heart rates of up to 600 beats per minute motivating the need for highest detector framerates while the coronaries show diameters below 100 µm indicating the requirement for highest spatial resolution. We herein use a custom built micro-CT equipped with dedicated reconstruction algorithms to illustrate that coronary imaging in mice is possible. The scanner provides a spatial and temporal resolution sufficient for imaging of smallest, moving anatomical structures and the dedicated reconstruction algorithms reduced radiation dose to less than 1 Gy but do not yet allow for longitudinal studies. Imaging studies were performed in ten mice administered with a blood-pool contrast agent. Results show that the course of the left coronary artery can be visualized in all mice and all major branches can be identified for the first time using micro-CT. This reduces the gap in cardiac imaging between clinical practice and preclinical research.
Asunto(s)
Angiografía por Tomografía Computarizada/métodos , Angiografía Coronaria/métodos , Vasos Coronarios/diagnóstico por imagen , Microtomografía por Rayos X/métodos , Animales , Angiografía por Tomografía Computarizada/instrumentación , Angiografía Coronaria/instrumentación , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Ratones Endogámicos C57BL , Microtomografía por Rayos X/instrumentaciónRESUMEN
BACKGROUND: Percutaneous coronary intervention exposes patient and staff to ionizing radiation. Although staff only receive a small fraction of patient dose through scatter radiation, there are concerns about the potential health effects of repeated exposure. Minimizing both patient and occupational exposure is needed. OBJECTIVE: This article investigates patient and operator X-ray exposure over time in coronary intervention in relation to upgraded X-ray equipment, improved shielding, and enhanced operator awareness. MATERIALS AND METHODS: Data regarding irradiation time, patient dose, and patient characteristics were extracted from the Norwegian Registry for Invasive Cardiology (NORIC) for procedures performed from 2013 to mid-2019. Personal operator dosimetry records were provided by the Norwegian Radiation and Nuclear Safety Authority. Improved operator shielding and awareness measures were introduced in 2018. RESULTS: In the period 2013 through June 2019, 21499 procedures were recorded in our institution. Mean dose area product (DAP) for coronary angiography decreased 37% from 2981 µGy·m2 in 2013 to 1891 µGy·m2 in 2019 (p < 0.001). For coronary intervention, DAP decreased 39% from 8358 µGy·m2 to 5055 µGy·m2. Personal dosimetry data indicate a 70% reduction in operator dose per procedure in 2019 compared to 2013. The most pronounced reduction occurred after improved radiation protection measures were implemented in 2018 (-48%). CONCLUSIONS: This study shows a temporal trend towards considerable reduction in X-ray doses received by the patient and operator during cardiac catheterization. Upgraded X-ray equipment, improved shielding, and enhanced operator awareness are likely contributors to this development.
Asunto(s)
Angiografía Coronaria , Intervención Coronaria Percutánea , Exposición a la Radiación/prevención & control , Salud Radiológica/tendencias , Angiografía Coronaria/instrumentación , Angiografía Coronaria/métodos , Angiografía Coronaria/normas , Humanos , Exposición Profesional/prevención & control , Intervención Coronaria Percutánea/instrumentación , Intervención Coronaria Percutánea/métodos , Intervención Coronaria Percutánea/normasRESUMEN
OBJECTIVE: To compare the performance of an 18-gauge nonfenestrated catheter (18-NFC) with a 22-gauge fenestrated catheter (22-FC) for cardiac CT angiography (CCTA) in patients with suspected coronary heart disease. SUBJECTS AND METHODS: 74 consecutive patients imaged on a 2nd generation dual-source CT with arterial phase CCTA were included in this retrospective investigation to either an 18-NFC or 22-FC. In comparison to the 18-NFC, the 22-FC has three additional perforations for contrast agent dispersal proximal to the tip. We examined the two groups for differences in their average attenuation in the right and left ventricles (RV, LV) and in the atrium (RA, LA) as well as in the proximal right coronary artery (RCA) and the left main coronary artery (LM). The averages were calculated for both the 18-NFC and 22-FC. RESULTS: Catheters were successfully placed on the first attempt 97% (36/37) for 18-NFC and 95% (35/37) for the 22-FC. The following enhancement levels were measured: 22-FC (in Hounsfield-Units (HU)): RV = 203±29, LV = 523±36, RA = 198±29, LA = 519±38, RCA = 547±26, LM = 562±25; 18-NFC: RV = 146±26, LV = 464±32, RA = 141±24, LA = 438±35, RCA = 501±23, LM = 523±23; RV (p = 0,03), LV (p = 0.12), RA (p = 0.02), LA (p = 0.04), RCA (p = 0.3), LM (p = 0.33). CONCLUSION: No significant differences in attenuation levels as well as in image quality of the coronary arteries were found between NFC and FC. Nevertheless, the 22-gauge FC examinations showed significantly higher attenuation in the left and right atrium as well as the right ventricle. Patients with poor venous access may benefit from a smaller gauge catheter that can deliver sufficiently high flow rates for CCTA.
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Angiografía por Tomografía Computarizada/instrumentación , Angiografía Coronaria/instrumentación , Enfermedad Coronaria/diagnóstico por imagen , Dispositivos de Acceso Vascular , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Medios de Contraste/administración & dosificación , Diseño de Equipo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto JovenRESUMEN
Coronary angiography and percutaneous coronary intervention via radial access has been progressively performed over the last three decades and has become standard of care. Even though the radial approach, compared with femoral access, is safe and is also associated with less bleeding in patients with myocardial infarction, it may be problematic in some cases. Here, we describe an 80-year-old woman with brachial artery dissection due to a twisted diagnostic catheter during transradial coronary angiography, who subsequently underwent surgical retrieval of the catheter.
Asunto(s)
Arteriopatías Oclusivas/cirugía , Arteria Braquial/cirugía , Catéteres/efectos adversos , Angiografía Coronaria/efectos adversos , Angiografía Coronaria/instrumentación , Cuerpos Extraños/etiología , Cuerpos Extraños/cirugía , Arteria Radial , Stents , Anciano de 80 o más Años , Arteriopatías Oclusivas/etiología , Femenino , Humanos , Resultado del TratamientoRESUMEN
BACKGROUND: To investigate the performance of a reconstruction algorithm, single-energy metal artifact reduction (SEMAR), against standard reconstruction in cardiac computed tomography (CT) studies of patients with implanted metal and in a defibrillator lead phantom. METHODS: From a retrospective, cross-sectional clinical study with institutional review board approval of 118 patients with implanted metal, 122 cardiac CT studies from November 2009 to August 2016 performed on a 320-detector row scanner with standard and SEMAR reconstructions were included. The maximum beam hardening artifact radius, artifact attenuation variation surrounding the implanted metal, and image quality on a 4-point scale (1-no/minimal artifact to 4-severe artifact) were assessed for each reconstruction. A defibrillator lead phantom study was performed at different tube potentials and currents with both reconstruction methods. Maximum beam hardening artifact radius and average artifact attenuation variation were measured. RESULTS: In the clinical study, SEMAR markedly reduced the maximum beam hardening artifact radius by 77% (standard: 14.8 mm [IQR 9.7-22.2] vs. SEMAR: 3.4 mm [IQR 2.2-7.1], p < 0.0001) and artifact attenuation variation by 51% (standard: 130.0 HU [IQR 75.9-184.4] vs. SEMAR: 64.3 HU [IQR 48.2-89.2], p < 0.0001). Image quality improved with SEMAR (standard: 3 [IQR 2-3.5] vs. SEMAR: 2 [IQR 1-2.5], p < 0.0001). The defibrillator lead phantom study confirmed these results across varying tube potentials and currents. CONCLUSIONS: SEMAR reconstruction achieved superior image quality and markedly reduced maximum beam hardening artifact radius and artifact attenuation variation compared to standard reconstruction in 122 clinical cardiac CT studies of patients with implanted metal and in a defibrillator lead phantom study.
Asunto(s)
Artefactos , Angiografía por Tomografía Computarizada/instrumentación , Angiografía Coronaria/instrumentación , Metales , Fantasmas de Imagen , Adulto , Anciano , Algoritmos , Estudios Transversales , Desfibriladores Implantables , Femenino , Prótesis Valvulares Cardíacas , Humanos , Masculino , Persona de Mediana Edad , Marcapaso Artificial , Valor Predictivo de las Pruebas , Diseño de Prótesis , Interpretación de Imagen Radiográfica Asistida por Computador , Reproducibilidad de los Resultados , Estudios RetrospectivosRESUMEN
OBJECTIVES: Aim of this study was to evaluate feasibility and benefit of self-designed, radiopaque markers as a novel technique in neonates and infants with shunt- or duct-dependent lesions. BACKGROUND: Surgically placed radiopaque markers have the potential to facilitate postoperative percutaneous interventions. METHODS: All consecutive children with surgically placed radiopaque markers involving systemic-to-pulmonary artery connections or arterial ducts in the context of hybrid palliation and subsequent cardiac catheterization between January 2013 and March 2019 were included in this analysis. Our primary endpoint was our concept's feasibility, which we defined as a combination of surgical feasibility and the percutaneous intervention's success. Secondary endpoint was the rate of complications resulting from the surgical procedure or during catheterization. RESULTS: Radiopaque markers that reveal the proximal entry of a surgical shunt or the arterial duct proved to be a feasible and beneficial approach in 25 postoperative catheterizations. The markers' high accuracy enabled easy probing and proper stent positioning in 13 neonates with a median age and weight of 121 days (range 9-356) and 4.7 kg (1.6-9.4) at the intervention. No procedural complications or unanticipated events associated with the radiopaque marker occurred. The markers were never lost, never migrated, and caused no local obstructive lesion. Surgical removal was straightforward in all patients. CONCLUSIONS: Radiopaque markers are a promising and refined technique to substantially facilitate target vessel access and enabling the accurate positioning of stents during postoperative percutaneous procedures.
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Cateterismo Cardíaco/instrumentación , Procedimientos Quirúrgicos Cardíacos , Angiografía Coronaria/instrumentación , Marcadores Fiduciales , Cardiopatías Congénitas/terapia , Radiografía Intervencional/instrumentación , Cateterismo Cardíaco/efectos adversos , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Estudios de Factibilidad , Cardiopatías Congénitas/diagnóstico por imagen , Cardiopatías Congénitas/fisiopatología , Humanos , Lactante , Recién Nacido , Valor Predictivo de las Pruebas , Prueba de Estudio Conceptual , Radiografía Intervencional/efectos adversos , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: Left ventricular diastolic dysfunction (LVDD) is a common abnormality among patients in T2DM. AIMS: We aimed to evaluate the feasibility of coronary computed tomography angiography (CCTA) for the assessment of LVDD in type 2 diabetes mellitus (T2DM) patients. METHODS: 80 consecutive T2DM patients who were referred for a clinically dual-source CCTA examination to evaluate suspected coronary artery disease and also underwent 2D echocardiography within 7 days of CCTA inclusion and exclusion criteria, were performed. Correlation between CCTA and echocardiography was tested through linear regression and Bland-Altman analysis. RESULTS: In total, 60 T2DM patients were included for the analysis. Pearson correlation showed good correlation for E (r = 0.28; P = 0.028), E/A (r = 0.69; P < 0.01); E (r = -0.06; P = 0.776), E/A (r = 0.54; P = 0.003) and E (r = 0.64; P < 0.01), E/A (r = 0.83; P < 0.01) in three groups, respectively. Overall, diagnostic accuracy for assessment in CCTA of diastolic dysfunction was 79.76% (95% CI: 68%-91%), 71.43% (95% CI: 58%-85%) and 87.50 (95% CI: 79%-96%) in three groups. CONCLUSION: The presented study proved that CCTA showed good correlations in the estimation of LV filling pressures compared with echocardiography in T2DM patients. Accordingly, retrospectively ECG-gated CCTA may provide valuable information on the evaluation of LVDD in T2DM patients.
Asunto(s)
Angiografía por Tomografía Computarizada/métodos , Angiografía Coronaria/métodos , Diabetes Mellitus Tipo 2/complicaciones , Disfunción Ventricular Izquierda/complicaciones , Disfunción Ventricular Izquierda/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Angiografía por Tomografía Computarizada/instrumentación , Angiografía Coronaria/instrumentación , Diabetes Mellitus Tipo 2/fisiopatología , Estudios de Factibilidad , Femenino , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Disfunción Ventricular Izquierda/fisiopatologíaRESUMEN
OBJECTIVE: To investigate the diagnostic performance of deep learning (DL)-based vascular extraction and stenosis detection technology in assessing coronary artery disease (CAD). METHODS: The diagnostic performance of DL technology was evaluated by retrospective analysis of coronary computed tomography angiography in 124 suspected CAD patients, using invasive coronary angiography as reference standard. Lumen diameter stenosis ≥50% was considered obstructive, and the diagnostic performances were evaluated at per-patient, per-vessel and per-segment levels. The diagnostic performances between DL model and reader model were compared by the areas under the receiver operating characteristics curves (AUCs). RESULTS: In patient-based analysis, AUC of 0.78 was obtained by DL model to detect obstructive CAD [sensitivity of 94%, specificity of 63%, positive predictive value of 94%, and negative predictive value of 59%], While AUC by reader model was 0.74 (sensitivity of 97%, specificity of 50%, positive predictive value of 93%, negative predictive value of 73%). In vessel-based analysis, the AUCs of DL model and reader model were 0.87 and 0.89 respectively. In segment-based analysis, the AUCs of 0.84 and 0.89 were obtained by DL model and reader model respectively. It took 0.47 min to analyze all segments per patient by DL model, which is significantly less than reader model (29.65 min) (p < 0.001). CONCLUSION: The DL technology can accurately and effectively identify obstructive CAD, with less time-consuming, and it could be a reliable diagnostic tool to detect CAD. ADVANCES IN KNOWLEDGE: The DL technology has valuable prospect with the diagnostic ability to detect CAD.
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Angiografía por Tomografía Computarizada/métodos , Angiografía Coronaria/métodos , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Estenosis Coronaria/diagnóstico por imagen , Aprendizaje Profundo , Anciano , Angiografía de Substracción Digital , Angiografía por Tomografía Computarizada/instrumentación , Angiografía por Tomografía Computarizada/normas , Angiografía Coronaria/instrumentación , Angiografía Coronaria/normas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Curva ROC , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
BACKGROUND: We have evaluated the feasibility of concomitant carotid angiography after coronary angiography with the same catheter, and the practicality, safety and success of image acquisition with respect to conventional catheters. METHOD: 248 patients have been enrolled in the study, who have been evaluated with both carotid and coronary angiography in a time period between 2010 and 2017. 117 of them were evaluated with right diagnostic catheters and 131 of them were evaluated with handmade S shaped (HMS) catheters. Basic parameters were similar in both of the groups. Total procedural time (7.34 ± 1.10 vs 9.56 ± 3.59 minutes, p < 0.001), fluoroscopy use time (6.08 ± 1.72 vs 5.23 ± 1.00 minutes, p < 0.001), used contrast media volume (50.2 ± 15.6 mL vs 62.3 ± 17.9 mL, p < 0.001) were all lower in the HMS catheter group. CONCLUSION: There is strong correlation between coronary and carotid artery disease (62%). Many Cardiologists perform concomitant carotid angiography when performing coronary angiography using right diagnostic catheters (JR). The JR catheters tip can be reshaped like to S to enhance its safety and efficacy during carotid imaging. Our experience supports this. Imaging of the carotid arteries is advantageous for the patients with severe coronary artery disease, when performing coronary angiography. For this purpose, the same catheter used for coronary imaging can be used after it is reshaped at hand, in place of a special catheter. This method is both efficient and safe.
Asunto(s)
Estenosis Carotídea/diagnóstico por imagen , Angiografía Coronaria/instrumentación , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Anciano , Catéteres Cardíacos , Diseño de Equipo , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVES: In this study, eye lens dose measurements were performed using two anthropomorphic phantoms simulating the cardiologist and patient during interventional procedures. BACKGROUND: Interventional procedures known as areas with high potential risk and the cardiologists can receive relatively high doses to their eyes. METHODS: This study was comprised of both phantom and computer simulations. Thermoluminescent dosimeters (TLDs) and mEyeDose_X tool were used to measure and calculate eye lens doses for the cardiologist. 144 TLDs measurements were performed using cardiac protocol for three angiographic projections: anterior-posterior (AP), left anterior oblique 90° (LAO90) and left anterior oblique 45° with cranial 30° (spider) angulations. All cine and fluoroscopy modes including the projections used in this study performed with and without protection tools. RESULTS: The annual equivalent doses with protective tools using mEyeDose_X were found to be 1.831 and 1.424â¯mSv/year, whereas the values using phantom were found to be 2.204 and 1.802â¯mSv/year for the lens of lift and right eye respectively. CONCLUSION: The annual doses reported in this study are almost comparable to other studies performed on interventional cardiology (IC) procedures. The highest dose rate in the lens was 20.21⯱â¯0.015â¯mSv/h without protective tools in cine mode for spider projection. Cardiologists may therefore easily exceed the lens dose limit if protective tools are not used.
Asunto(s)
Cardiólogos , Angiografía Coronaria , Cristalino/efectos de la radiación , Exposición Profesional , Salud Laboral , Exposición a la Radiación , Radiografía Intervencional , Radiólogos , Simulación por Computador , Angiografía Coronaria/efectos adversos , Angiografía Coronaria/instrumentación , Humanos , Exposición Profesional/efectos adversos , Fantasmas de Imagen , Exposición a la Radiación/efectos adversos , Radiografía Intervencional/efectos adversos , Radiografía Intervencional/instrumentación , Medición de Riesgo , Factores de Riesgo , Dosimetría Termoluminiscente , Factores de TiempoRESUMEN
OBJECTIVES: We sought to compare the procedural and clinical performance of dual- versus single-catheter strategy for transradial coronary angiography. BACKGROUND: The radial artery (RA) is recommended as the vascular access of choice in patients undergoing coronary angiography and intervention. The procedural and clinical performance of dual- versus single-catheter strategy in patients undergoing transradial coronary angiography remains a matter of debate. METHODS: This is a study-level meta-analysis of randomized trials. The primary outcome was procedure time. The main secondary outcome was fluoroscopy time. Other outcomes of interest were contrast volume, crossover to other catheter strategy and RA spasm. RESULTS: A total of 2,062 patients (978 randomly assigned to dual-catheter and 1,084 to single-catheter strategy) included in seven trials were available for the quantitative synthesis. A dual-catheter strategy was associated with procedure time (standardized mean difference [95% confidence intervals (CI)], 0.55 [-0.69, 1.78]; p = .32), fluoroscopy time (-0.36 [-2.39, 1.67]; p = .68) and contrast volume (-0.93 [-3.79, 1.94]; p = .44) comparable to a single-catheter strategy. The risk for crossover was lower (risk ratio [95% CI], 0.14 [0.03, 0.70]; p = .025) while the risk for RA spasm was higher (1.81 [1.54, 2.12]; p < .001) among patients assigned to dual- versus single-catheter strategy. CONCLUSIONS: This meta-analysis provides evidence for a comparable procedural performance of either dual- or single-catheter strategy for transradial coronary angiography. The fewer crossovers with dual-catheter strategy occur at the expense of more frequent radial artery spasm.