Selective catheterization of the brachiocephalic arteries via the right brachial artery

Summary Selective intra-arterial digital subtraction angiography of the brachiocephalic arteries using the right brachial artery approach was successfully performed for 169 of 173 patients, 33 of whom were outpatients. Catheterization was unsuccessful for four patients; two of them elderly hypertensive men with tortuous brachial arteries, and two of them middle-aged obese women for whom arterial puncture could not be performed. 4-F modified Simmons type catheters were used in this study. Selective catheterizations of both common carotid arteries were successfully performed in all but one patient, a woman whose aberrant right subclavian artery prevented bilateral common carotid arterial catheterizations. Selective catheterizations of the right vertebral and left subclavian arteries, though relatively difficult, were successfully performed in 84.2% and 93.9% of patients, respectively. The mean examination time for a four-vessel study was 24.3 min. No major complications were encountered. Thus, transbrachial selective catheterization of the brachiocephalic arteries proved to be safe, useful, and relatively easy to perform.     

Right brachial angiography with compression

Summary A technique for performing right brachial angiography by compressing the right anterior-inferior part of the neck is proposed, as a result of studying the left carotid circulation without puncturing the left carotid artery. A success was obtained in about 75% of cases. The success of the technique depends mainly on the anatomical nature of the innominate artery. When the technique is successful both left carotid arteries in the neck and their intracranial branches can be satisfactority visualized. In some cases visualization of the left vertebral artery was also obtained. Attention is drawn also on the increased diagnostic possibilities of studying the vessels in the neck with a greater dilution of the contrast medium.Abbreviations RBA right brachial angiography - LBA left brachial angiography - RBAC right brachial angiography with compression - PCLCA percutaneous countercurrent left carotid angiography Presented at the 6th Congress of the French Society of Neuroradiology, Tours, May 1981     

Preserved vascular reactivity in elderly male athletes

The objective was to characterise function and morphology of the arterial wall in 9 elderly men (mean age 75 +/- 3.4 years) with a history of lifelong regular strenuous exercise. A control group of 11 healthy sedentary or moderately physically active men (74.5 +/- 2.7 years) was also studied. With increasing age atherosclerosis becomes more common and endothelium-dependent vasodilation reduced. The effects of training on endothelial function and atherosclerosis have not been studied previously in elderly subjects. High-frequency ultrasound was used to estimate vasodilatory function in the brachial artery. The endothelium-dependent (flow-mediated) and non-endothelium-dependent (nitroglycerine-induced) dilation of the brachial artery were measured. Stasis was used to induce reactive hyperaemia. The carotid arteries were scanned for plaques, intima-media thickness was measured in the common carotid arteries and arterial wall stiffness was calculated from pulsatile diameter changes in the right carotid artery in relation to blood pressure. The athletes' maximal oxygen uptake during treadmill exercise was 2.90 +/- 0.50 l or 41 +/- 7 ml.kg-1. The athletes' and the controls' maximal exercise capacity on a bicycle was 254 +/- 38 W and 148 +/- 19 W respectively (P < 0.001). The athletes' body mass index was 22.6 +/- 2.6 kg.m-2 and the controls' body mass index was 25.8 +/- 3.5 kg.m-2 (P = 0.037). Three of 9 athletes had plaques in either or both carotid bifurcations compared with 6 of 11 controls. The athletes had less stiff arteries and better vasodilatory capacity in the brachial artery during increased flow, and borderline significantly greater vasodilation after nitroglycerine. So, elderly athletes with a lifelong training history appear to have better vasodilatory capacity and less stiff arteries than healthy controls. Plaques in the carotid bifurcation were common in both athletes and controls.     

Usefulness of selective cerebral angiography by transradial approach

Transradial angiography has recently emerged as an alternative to the transfemoral or transbrachial approach, especially for coronary procedures. However, there have been few studies on cerebral angiography using the transradial approach. The purpose of this study was to assess the outcomes, complications, and limitations of selective cerebral angiography via the transradial approach. Selective cerebral angiography by the right transradial approach using 100-cm-long 4-F catheters was performed in 83 patients. Using five types of catheters, the success rates of selective catheterization to the right vertebral artery, right common carotid artery, left common carotid artery, and left vertebral artery were 40/44 (91%), 68/68 (100%), 62/62 (100%), and 14/25 (56%), respectively. Puncture failed in one patient, and a guidewire could not be introduced beyond the radial artery loop in one patient. Radial artery spasm occurred in one patient, but was relieved immediately after nitroglycerin injection through the sheath with side holes. Subcutaneous bleeding occurred in six patients, but no obvious hematomas were noted. Occlusion or stenosis of the radial artery occurred in five patients, but no ischemic symptoms were observed in any of the cases. This study suggested that selective cerebral angiography can be performed safely using the transradial approach.     

Carotid stenting through the right brachial approach for left internal carotid artery stenosis and bovine aortic arch configuration

Unfavorable complex anatomy or congenital anomalies of supra-aortic vessel take-off may increase carotid artery stenting (CAS) procedural difficulties and complications through the femoral route. We assessed the feasibility, safety, and efficacy of CAS through the right brachial approach in patients in whom left internal carotid artery stenosis and bovine aortic arch configuration were identified with computed tomography (CT) angiography. Bovine configuration of the aortic arch and left carotid artery stenosis were easily identified by CT angiography and successfully treated through the right brachial approach technique.     

Anatomical variations of the carotid bifurcation: implications for digital subtraction angiography and ultrasonography

Intravenous digital subtraction angiography was used to determine prospectively the positional variations of the common carotid bifurcation in 100 consecutive patients with clinically suspected arteriosclerotic disease. The most common position (97/200, 48.5%) of the external carotid artery was anteromedial to the internal carotid artery. Position of the external carotid artery anterolateral to the internal carotid artery was noted in 26/200 (13%) bifurcations, but this anatomical variant was more common on the right (21/100) than on the left (5/100) (p less than 0.01). Practical implications may be drawn from this study. For digital subtraction angiography, the left anterior oblique view has to be considered the projection of choice and the right common carotid bifurcation is less likely to be adequately displayed than the left one; for duplex ultrasonography, optimal visualization is obtained from a posterolateral orientation of the transducer.     

Innominate artery occlusive disease: sonographic findings

OBJECTIVE: The objective of this study was to report the sonographic abnormalities in a group of patients with angiographically proven innominate artery stenosis and occlusion. MATERIALS AND METHODS: A review of all cerebrovascular sonograms at our institutions was undertaken to identify patients with complete or partial flow reversal in the right vertebral artery and reversal or midsystolic deceleration of flow in any one of the three major segments of the right carotid system (common, internal, or external carotid artery). The distribution and appearance of these abnormalities was evaluated, and the presence or absence of tardus-parvus waveforms was noted in any segment of the right carotid artery. Additionally, a left to right common carotid peak systolic velocity ratio (LCCA/RCCA) was calculated and compared to published normal values. All patients had correlative contrast or MR angiography. Correlation was made between the severity of stenosis as determined by angiographic images and waveform aberrations as well as the more objective LCCA/RCCA ratios. RESULTS: Twelve patients were identified as having the abnormalities described above in the right vertebral and carotid arteries. Doppler waveforms from the right vertebral artery revealed that eight of the 12 patients had complete reversal of flow at rest. Bidirectional flow was found in the remaining four as manifested by the presence of marked midsystolic deceleration. In the carotid arteries, one patient had complete reversal of flow in all segments of the right carotid system. Waveforms with midsystolic deceleration were identified in at least one of the carotid arteries of the remaining 11 patients: common carotid artery (8/11 = 73%), internal carotid artery (10/11 = 91%), external carotid artery (3/11 = 27%). The average LCCA/RCCA was 3.1 with a range of 1.7 to 5.7 (normal = 0.7-1.3). All patients had severe innominate artery disease (from 70% to occlusion) by contrast angiography or MR angiography. There was no correlation between the angiographically determined degree of stenosis and the Doppler findings. CONCLUSION: A distinctive pattern of hemodynamic alterations occurs in the right vertebral and carotid arteries of patients with severe innominate artery disease. Findings include reversed or bidirectional flow in the right vertebral artery, the presence of midsystolic deceleration in any of the branches of the right carotid system, and elevated LCCA/RCCA ratio.     

New Technique for the Preservation of the Left Common Carotid Artery in Zone 2a Endovascular Repair of Thoracic Aortic Aneurysm

To describe a technique for the preservation of the left common carotid artery (CCA) in zone 2 endovascular repair of thoracic aortic aneurysm. This technique involves the placement of a guide wire into the left CCA via the right brachial artery before stent graft deployment to enable precise visualization and protection of the left CCA during the whole procedure. Of the 107 patients with thoracic endovascular aortic repair in our study, 32 (30%) had the left subclavian artery intentionally covered (landing zone 2). Eight (25%) of those 32 had landing zone 2a—the segment distally the origin of the left CCA, halfway between the origin of the left CCA and the left subclavian artery. In all patients, a guide wire was positioned into the left CCA via the right brachial artery before stent graft deployment. It is a retrospective study in design. In seven patients, stent grafts were positioned precisely. In the remaining patient, the positioning was imprecise; the origin of the left CCA was partially covered by the graft. A stent was implanted into the left CCA to restore the flow into the vessel. All procedures were performed successfully. The technique of placing a guide wire into the left CCA via the right brachial artery before stent graft deployment is a safe and effective method that enables the precise visualization of the left CCA during the whole procedure. Moreover, in case of inadvertent complete or partial coverage of the origin of the left CCA, it supplies safe and quick access to the artery for stent implantation.     

异物创伤性动脉瘤犬模型构建的初步探讨

目的：建立异物创伤性动脉瘤的犬模型,为伴血管损伤软组织异物一站式介入治疗研究提供动物模型。 方法：随机选取2年龄的健康雄性比格犬7只,分为颈动脉瘤造模5只和未造模2只,造模于右侧颈动脉共5支血管为研究组,其左侧颈动脉及未造模2只犬两侧颈动脉共9支血管为对照组。研究组将长约15~20 mm的离断颈静脉剪开、缝合于同侧颈总动脉前璧上,以弯型断针穿破静脉片及动脉前壁,静脉片-动脉壁间腔搏动性充盈且无缝缘渗漏后,断针部分留存于该间腔甚或动脉腔内,逐层缝合手术区域组织。然后,经皮经股动脉插管选择性颈总动脉进行数字减影血管造影（DSA）。对照组颈动脉仅于其旁以缝针经皮扎伤软组织且无明显出血及血肿。术前、术后行颈部CT血管成像（CTA）和数字放射摄影（DR）检查与评估。 结果：研究组5支右侧颈动脉断针创伤性动脉瘤均成功造模,技术成功率100%;DSA清晰显示动脉破口、动脉瘤状动脉突起及断针异物,载瘤动脉局部轻度痉挛及狭窄,创伤性动脉瘤模型的瘤颈宽度为（2.1±1.3）mm,瘤体宽（9.7±1.1）mm,瘤体高（4.2±1.7）mm;CTA不如DSA显示效果佳。对照组9支颈动脉均正常。 结论：采用颈静脉片侧-侧吻合于同侧颈动脉前壁上并以断针穿破静、动脉壁且断针部分留置于其间的技术与方法,成功构建了异物创伤性动脉瘤犬模型。     

不同部位注射对比剂对颈动脉血管CT造影图像质量的影响

 目的 探讨通过左、右肘注射对比剂对颈动脉CT造影(CTA)成像图像质量的影响。方法 回顾性分析2019-09至2021-06在武警北京总队医院医学影像科行头颈部CTA检查的100例患者,其中50例经右臂肘正中静脉注射对比剂的为右臂组,50例经左臂肘正中静脉注射对比剂的为左臂组;对比两组患者两侧颈动脉CT值及静脉显影优良率。结果 右臂组及左臂组的左颈总动脉CT值分别为(335.25±20.67)Hu、(315.78±20.67)Hu,右颈总动脉CT值分别为(330.28±18.45)Hu、(313.56±19.45)Hu,差异无统计学意义(P＞0.05);右臂组静脉显影优良率为86.00%,高于左臂组的63.00%,差异有统计学意义(P＜0.05)。结论 颈动脉CT血管造影采用右臂静脉注射对比剂,可减少上腔静脉、头臂静脉、锁骨下静脉伪影及对比剂反流。     

On the symmetry and asymmetry of the bifurcation of the common carotid artery

Summary Bilateral carotid angiograms of the neck in 100 consecutive adult patients show the bifurcation of the left common carotid artery to be located cranial to the right in 50% of the cases, while the right bifurcation was higher in 22%. The origin of the internal carotid artery was at the dorsal or dorsolateral aspect of the common carotid artery in 82% on the right side and in 94% on the left, while a dorsomedial or medial origin was found in 18% on the right side and in 6% on the left.     

Endovascular Repair of a Right-Sided Descending Thoracic Aortic Aneurysm Associated with a Right Aortic Arch and a Left Subclavian Artery Arising from a Kommerell’s Diverticulum

This case report describes the endovascular repair of a right-sided descending thoracic aortic aneurysm associated with a right aortic arch and an aberrant left subclavian artery. A 76-year-old male with multiple comorbidities was incidentally found to have a right-sided descending thoracic aortic aneurysm with a maximum diameter of 6.2 cm. Additionally, there was a right aortic arch with a retroesophageal segment and separate arch branches arising in the following order: left common carotid artery, right common carotid artery, right subclavian artery, and left subclavian artery that was aberrant, arising from a Kommerrell’s diverticulum. The aneurysm was successfully excluded by deployment of a Zenith TX1 36 × 32 × 20-mm stent-graft using wire traction technique via the left femoral and right brachial arteries in order to deal with two severe aortic angulations. At 18-month follow-up the patient was doing well, with aneurysm sac shrinkage to 5.9 cm and no signs of endoleak or migration. Endovascular repair of right-sided descending thoracic aortic aneurysms with a right arch and aberrant left subclavian artery is feasible, safe, and effective. In such rare configurations, which demand considerably increased technical dexterity and center experience, endovascular repair emerges as an attractive therapeutic option.     

New catheter technique for transcubital intraarterial DSA of the aortic arch and the supraaortic vessels

Summary A new catheter for the intraarterial DSA of the aortic arch and the selective demonstration of the supraaortal branches is presented. The catheter is introduced through the right cubital artery (introduction is also possible through the brachial or the axillary artery), which is favorable for performing the examination on ambulant patients. A technique for performing angiography in the region of the aortic arch and one for the selective demonstration of all supraaortic vessels, without the need to change catheters, is described. The authors have used the new technique on 200 patients who were referred for a DSA examination as a result of suspected CVI. Good selective demonstration of all the supraaortic vessels was achieved in 155 patients (77.5%). In the remaining patients we had to do without selective demonstration of the subclavian artery or the carotid artery. Even in these cases, the innominate artery and its branches could be selectively demonstrated. The advantages of the new catheter technique are clear in performing intraarterial DSA on ambulant patients, and by using only one catheter for demonstration of the aortic arch and selective demonstration of all the supraaortic arteries in the extra- and intracranial region. The advantages of transcubital puncture and also its complications are dealth with.     

Cerebrovascular disease: outpatient evaluation with selective carotid DSA performed via a transbrachial approach

A total of 355 outpatients and 73 inpatients were studied for cerebrovascular disease with intraarterial digital subtraction angiography (DSA). The studies were performed by means of selective carotid and vertebral artery catheterization from a transbrachial approach. Selective catheterization of the carotid artery was possible in 95% of patients, with definitive examinations of both extra- and intracranial circulation obtained in 95%-100% of all patients. Vessel opacification was very good to excellent, and the technique was inherently free from artifact caused by vessel overlap or involuntary motion. There were 25 complications, of which 20 were local in nature. Iodine load per case was extremely low, averaging 4.2-7.0 g. Selective carotid and vertebral catheterizations by the brachial route proved to be as safe as intravenous DSA and aortic arch intraarterial DSA with less contrast material load and superior images.     

流量介导的肱动脉扩张与颈动脉内中膜厚度对冠心病诊断作用比较

目的:冠心病患者流量介导的肱动脉扩张(flow-mediated vasodilation,FMD)减低,颈动脉内中膜厚度(intima-mediathickness,IMT)增厚,但两者对冠心病是否具有诊断作用尚未可知,本文主要探讨肱动脉FMD与颈动脉IMT对冠心病有无诊断作用。方法:在具有冠心病危险因素、具有典型的冠心病临床表现而且行冠状动脉造影检查的患者中,选取50位经冠状动脉造影明确患有冠心病的患者作为冠心病组,50位经冠状动脉造影检查明确没有冠心病的患者作为对照组,分别测量每位患者的肱动脉FMD和颈动脉IMT,通过单因素分析及多因素分析观察两者对冠心病的诊断作用。结果:冠心病组的肱动脉FMD较对照组低,颈动脉IMT较对照组厚,单因素分析发现高脂血症、糖尿病、肱动脉FMD以及颈动脉IMT与冠心病的发生密切相关,而在多因素回归分析中,仅有肱动脉FMD与冠心病的发生密切相关,以FMD<6%为标准,其对冠心病的诊断的敏感性为92%,特异性为88%。结论:肱动脉FMD对冠心病具有诊断价值,IMT则不能用来诊断冠心病。     

Wall shear rates differ between the normal carotid, femoral, and brachial arteries: an in vivo MRI study

PURPOSE: To investigate wall shear rates in vivo in the common carotid, brachial, and superficial femoral arteries using very high resolution magnetic resonance imaging (MRI) phase contrast measurements. MATERIALS AND METHODS: Mean, maximum, and minimum wall shear rate and an oscillatory shear index were measured for 20 volunteers, aged 23.3 +/- 1.9 years, in the three arteries, using phase contrast imaging with 0.0625 mm2 resolution and three-dimensional paraboloid fitting. RESULTS: The superficial femoral artery had the lowest mean (130.3 +/- 13.1 second(-1)), maximum (735.8 +/- 32.4 second(-1)), and minimum (-224.5 +/- 17.0 second(-1)) wall shear rate, as well as the highest oscillatory shear index (0.21 +/- 0.02). All values were significantly different (P < 0.05) from both the brachial artery and the common carotid artery values. The highest mean (333.3 +/- 13.6 second(-1)) and minimum (117.9 +/- 24.5 second(-1)) wall shear rates and the lowest oscillatory shear index (0 +/- 0) were found in the common carotid artery. CONCLUSION: It is possible to measure wall shear rate in vivo in different arteries using MRI with very high resolution. The findings exhibit the in vivo environment of wall shear rates and suggest a nonuniform distribution of wall shear rates throughout the arterial system.     

慢性脑供血不足患者颈总动脉检测及高压氧对肱动脉内皮依赖性舒张功能影响的评价

目的:检测慢性脑供血不足(CCCI)患者颈总动脉并评价高压氧对其肱动脉内皮依赖性舒张功能(EDD)的影响.方法:用彩色多普勒超声检测62例患者颈总动脉内中膜厚度(IMT)和斑块情况,并分别于高压氧治疗前及治疗10d后检测肱动脉EDD值,同时测定其血清NO和ET水平.结果:与正常人群(0.65±0.12)mm比较,所有C...     

Effects of iodinated contrast media on common carotid and brachial artery blood flow and wall shear stress

The aim of our study was to evaluate the effect of the intravenous contrast media iomeprol on wall shear stress, blood flow and vascular parameters in the common carotid and brachial artery. Thirty outpatients undergoing thoracic or abdominal spiral CT scans were studied. The internal diameter and flow velocity of the common carotid and brachial artery were evaluated by ultrasound, and blood viscosity was measured before and after low osmolality iomeprol (Iomeron 350) injection. The wall shear stress, blood flow and pulsatility index were calculated. To test the differences between groups, the Wilcoxon rank test and Mann Whitney U test were applied. Blood viscosity decreased slightly, but significantly after contrast media (4.6±0.7 vs. 4.5±0.7 mPa.s, P=0.02). Contrarily, blood flow and wall shear stress did not change in the common carotid artery, but significantly decreased in the brachial artery (0.9±0.4 vs. 0.6±0.3 ml/s, P<0.0001, and 41.5±13.9 vs. 35.3±11.0 dynes/cm2, P<0.002, respectively), whereas the pulsatility index significantly increased in the brachial artery (5.0±3.3 vs. 7.5±5.3, P<0.001). Iomeprol injection causes blood flow and wall shear stress reduction of the brachial artery; the rise in the pulsatility index suggests an increase in peripheral vascular resistance. Further investigation is needed to evaluate whether these modifications can be clinically relevant.An erratum to this article can be found at     

The transradial approach for selective carotid and vertebral angiography

Purpose:
The transradial approach is not so popular in cerebral angiography. The purpose of this study was therefore to present our experience of success rate and safety of this method. Material and Methods:
From December 1998 to June 2001, 526 carotid and vertebral angiographies with DSA were performed via the radial artery. A 1.4-mm catheter was used through a 1.4-mm introducer sheath. We evaluated the procedure as successful if sufficient images for diagnosis were obtained of the bilateral carotid arteries and unilateral vertebral artery. Each patient was reassessed for any complications, occurring until the next morning. The length of time needed for an examination was measured in the last 10 cases. Results:
In all but 5 cases, the procedures were evaluated as successful (99.0%). Unsuccessful cases manifested severe pain at the radial puncture, angiospasm at the radial artery, loop formation at the radial artery, occlusion at the subclavian artery, and an aberrant right subclavian artery. No severe complications including neurological ones were encountered. Minor complications were noted in 17 cases (3.2%): 4 cases of thrombus at the ulnar artery, 1 angiospasm at the radial artery, and 12 cases of small hematoma at the puncture site. The radial approach took 14 min less in the common carotid study and 3 min 30 s less in the internal carotid study than by the femoral approach. Conclusion:
The transradial approach enabled selective studies for carotid and vertebral angiography with a high success rate and safety with few complications.     

Carotid and vertebral artery blood flow in left- and right-handed healthy subjects measured with MR velocity mapping

The goal of the study was to establish normal carotid artery flow rates in left-handed and right-handed individuals as a standard against which patients with carotid artery disease could be compared. Antegrade and retrograde flow were measured in the ascending aorta, in the right and left common, internal, and external carotid arteries, and in the vertebral arteries of 12 healthy subjects. Five subjects were right-handed, five left-handed, and two ambidextrous. Measured flow rates were as follows: common carotid arteries, 360–557 mL/min (mean [± standard deviation], 465 mL/min ± 52); internal carotid arteries, 132–367 mL/min (mean, 265 mL/min ± 60); external carotid arteries, 113–309 mL/min (mean, 186 mL/min ± 51); vertebral arteries from 133–308 mL/min (mean, 244 mL/min ± 43); and cerebral circulation, 546–931 mL/min (mean, 774 mL/min ± 134). All right-handed subjects had higher flow rates in the left internal carotid artery than in the right, and all left-handed subjects had higher flow rates in the right internal carotid artery (P =.007). There were no significant differences in left and right common carotid artery flow rates between left- and right-handed subjects. The standard deviation of a single measurement was 5%. The flow rates were similar to those obtained previously with other techniques and could be used as a normal standard.