The angiographic appearance of the coronary arteries in constrictive pericarditis.

Coronary artery motion was evaluated in normal subjects and patients with constrictive pericarditis (CP), congestive cardiomyopathy, restrictive cardiomyopathy, and coronary artery disease. Seven of the 8 patients with CP had lack of motion of the major coronary arteries. Nine of the 10 patients with congestive cardiomyopathy and a markedly reduced ejection fraction showed normal motion, as did all 4 with restrictive cardiomyopathy and 9 of the 10 with segmental dysfunction due to coronary disease. Pericardial stripping in 5 patients with CP revealed epicardial involvement corresponding to regions of absent motion; one CP patient with normal motion had no epicardial involvement. Lack of motion may suggest CP when the diagnosis is unsuspected, right heart pressures are not obtained, or hemodynamics are atypical. This sign may also help to distinguish CP from restrictive cardiomyopathy, which produces similar hemodynamics.     

Aneurysms of persistent trigeminal arteries

Summary Two cases of asymptomatic aneurysm of a primitive trigeminal artery, discovered incidentally at angiography for other reasons, are presented.     

缺血性脑卒中的颅内血管造影表现及评价

脑卒中是严重危害人类健康的疾病之一.我国脑血管病死亡率仅次于肿瘤.随着介入器材及技术的发展,经动脉溶栓及血管内支架置入治疗脑卒中取得较好的疗效,越来越引起人们重视.正确理解缺血性脑卒中的血管造影表现在介入治疗及疗效评价方面有重要意义.神经介入医师不仅要有娴熟的导管技术,还应熟悉神经血管解剖、病理状况下的血流动力学改变、Willis环及其他重要侧支血管的解剖及其代偿作用.如果梗死发生在较细小的血管,常需要观察动脉期、毛细血管期、静脉期才能作出正确诊断.病变部位及侧支循环的状况也影响到梗死面积的大小及预后.     

Sarcoma of the kidney: angiographic features.

Sarcomas of the kidney are highly malignant neoplasms. Abnormal vascularity can be detected in almost all types of sarcomas, but arteriovenous shunting, pooling of contrast material, and tumor staining are seldom present. Extension to renal vein and inferior vena cava may occur. While angiographic findings in our seven cases of renal sarcomas were nonspecific, this diagnosis should be considered in a relatively hypovascular neoplasm especially when the capsular arteries contribute considerably to the vascular supply. Nevertheless, statistically the most likely diagnosis of a hypovascular mass is renal cell carcinoma. Angiographic studies do not alter the management of the patient but merely suggest the diagnostic possibility of sarcoma. Angiographic diagnosis of different histologic types of sarcomas is not possible.     

Vasoconstriction by angiographic contrast media in isolated canine arteries.

To study the mechanism of the pain produced by contrast media (CM) in peripheral arteriography, we examined the direct effects of low concentrations (1.85-100 mg I/ml) of CM (diatrizoate, iopamidol, ioxaglate, and iotrolan) on helically cut strips of canine blood vessels taken from six different regions. We found that: (a) low concentrations of CM induced vasoconstriction. (b) This occurred immediately after the application of CM and produced sustained constriction. (c) The constriction produced in arteries was dose-dependent. (d) The production and intensity of constriction in the arterial strips differed as follows: cranial mesenteric artery > renal artery > femoral artery > common carotid artery > thoracic aorta > coronary artery. The effects of the CM were, in order of magnitude: diatrizoate > iopamidol > ioxaglate > iotrolan. Differences between CM corresponded with the differences in osmolality of the CM solutions. (e) Low concentrations of meglumine and mannitol also produced vasoconstriction. (f) Constriction caused by all drug samples used was reversible, but the process of relaxation to the original tension was much slower in CM-treated arterial strips than in the other strips. From these results, we confirmed that the incidence and degree of vasoconstriction produced by all drug samples used in this experiment depended on solution osmolality, rather than on chemotoxicity or ionicity. We discuss the physiological mechanism of these results and stress the importance of CM hyperosmolality in vasoconstriction and vascular pain production.     

Aneurysms of the vein of Galen in children: CT and angiographic correlations

Summary An aneurysm of the vein of Galen is a rare midline arteriovenous malformation. The clinical signs and the prognosis strictly depend on age of presentation and on the amount of blood shunted into the malformation. In the newborn, cardiac failure is the most common presenting sign. In older children hydrocephalus, headache, focal neurological signs and subarachnoid bleeding may be the reason for admission. At the Hospital for Sick Children six patients with an aneurysm of the vein of Galen were studied by angiography and CT. Four of them were newborn in cardiac failure. Angiography was essential for the accurate demonstration of all the feeding vessels to the malformation and their exact location. Computed tomography also added useful information on associated hydrocephalus and ischemic brain damage. The dilated vein of Galen, straight sinus and torcular were clearly seen. Abnormal arterial vessels feeding the malformation were also recognized.     

Nonhepatic arteries originating from the hepatic arteries: angiographic analysis in 250 patients

PURPOSE: To investigate the prevalence and patterns of origin of nonhepatic arteries originating from the proper hepatic artery (PHA) or its distal branches and to assess their relation to anatomic variations. MATERIALS AND METHODS: Digital subtraction celiac arteriography and selective left hepatic arteriography was performed in 250 patients with hepatocellular carcinoma. Three interventional radiologists interpreted the angiograms on the monitor by consensus. If necessary, further superselective arteriography was performed. The prevalence of nonhepatic arteries, their sites of origin, and the influence of underlying anatomic variants were analyzed. RESULTS: Nonhepatic arteries were found in 205 patients. The most common nonhepatic artery was the right gastric artery (RGA; n = 196), followed by the hepatic falciform artery (HFA; n = 129), accessory left gastric artery (LGA; n = 43), posterior superior pancreaticoduodenal artery (PSPDA; n = 18), and left inferior phrenic artery (LIPA; n = 5). The left hepatic artery (LHA) was the most frequent origin of nonhepatic arteries (170 of 250). Regardless of anatomic variation, the most common origins of the RGA and HFA were the PHA and the segment IV hepatic artery, respectively. In patients with an aberrant LHA from the LGA, no accessory LGAs or LIPAs were found. PSPDAs preferentially arose from variant hepatic arteries arising from the gastroduodenal artery. CONCLUSIONS: Nonhepatic arteries commonly arise from the hepatic arteries, especially the LHA and PHA. Moreover, variants of the celiac and hepatic arteries influence the prevalence and sites of origin of nonhepatic arteries.     

Inhibition of restenosis in stented porcine coronary arteries: uptake of Paclitaxel from angiographic contrast media

RATIONALE AND OBJECTIVES: Paclitaxel added to angiographic contrast medium (CM) has been shown to inhibit restenosis in the porcine coronary overstretch model. This study determined early local tissue concentrations after the administration of different paclitaxel doses and preparations. MATERIALS AND METHODS: Fifteen pigs received 2 stents each in the left coronary artery. During and/or after the intervention, paclitaxel-containing CM or diluted Taxol was injected. Fifteen minutes after the last intracoronary injection, paclitaxel concentrations in the arterial wall and myocardium were measured by high-performance liquid chromatography. RESULTS: Mean paclitaxel concentrations in the left coronary arteries reached 3-10 microM. Higher volumes and higher paclitaxel concentrations resulted in higher tissue concentrations. Paclitaxel in CM was better tolerated and led to higher local concentrations than diluted Taxol. Low paclitaxel concentrations in the uninjected right coronary artery and in plasma indicate selectivity. CONCLUSION: When admixed to CM, paclitaxel results in local tissue concentrations proportional to the amount of the drug injected.     

Clinical and angiographic features of pulmonary arteriovenous fistulas in children.

Multiple pulmonary arteriovenous fistulas were demonstrated angiographically in 8 patients who exhibited cyanosis and polycythemia during childhood. Cyanosis was first observed during infancy in 5 patients. The diffuse (telangiectatic) type was present in 2 cases, while the remainder were of the multiple discrete type with one or two dominant fistulas. The clinical and angiographic features and surgical implications of multiple pulmonary arteriovenous fistulas in these children and those reported previously are discussed.     

The angiographic features of extraabdominal desmoid tumors.

Extraabdominal desmoid tumors are nonencapsulated locally invasive neoplasms of fibrous tissue. The angiographic features include arterial stretching, neovascularity, and tumor staining (4 of 6 cases in this series). Although benign, these tumors are difficult to cure because they tend to recur locally.     

Aneurysms related to cerebral arteriovenous malformations: superselective angiographic assessment in 58 patients.

PURPOSETo report the comprehensive superselective angiographic characteristics of aneurysms associated with cerebral arteriovenous malformations.METHODOne hundred consecutive patients referred for cerebral arteriovenous malformation embolization underwent preembolization superselective angiography. Superselective angiograms were obtained after microcatheterization of arteriovenous malformation pedicles, and assessed for number and location of aneurysms related to the malformation. A chi 2 test was conducted to correlate these parameters with the onset of intracranial hemorrhage.RESULTSAneurysms were demonstrated in 58 of 100 patients. Single aneurysms were found in 24 patients and multiple aneurysms in 34. Presence and number of aneurysms were found to correlate significantly with a clinical presentation of hemorrhage.CONCLUSIONSuperselective angiography was found to be of paramount importance in elucidating the precise and detailed angioarchitecture of brain arteriovenous malformations.     

Clinical and angiographic features of nonspecific aorto-arteritis in children and adults.

We compared clinical and angiographic features of nonspecific aorto-arteritis in children with those of adult patients. Digital subtraction angiography by i.v. and/or i.a. injection was carried out in 104 patients. In group 1, consisting of 32 patients aged 16 years and younger, hypertension (75%) was the most common clinical feature, followed by diminished pulse, bruit (72% each), congestive cardiac failure (38%), and limb claudication (13%). Obstructing arterial lesions were always present and commonly involved the abdominal aorta (75%), descending thoracic aorta (41%), renal (63%) and subclavian (41%) arteries. In Group 2, consisting of 72 patients more than 16 years of age, arterial bruit (91%), and diminished pulse (82%) were the most common symptoms. Hypertension occurred in 61%, congestive failure in 14%, and limb claudication in 30%. Obstructing lesions were always seen and commonly involved the abdominal aorta (77%) and renal arteries (64%). Involvement of the descending thoracic aorta (26%) was less common but subclavian (57%) and carotid (24%) arteries were more commonly involved than in group 1. Arterial aneurysms and pulmonary involvement were uncommon in both groups. There were some clinical and angiographic differences in nonspecific aorto-arteritis between children and adults but these were statistically insignificant (chi-square test).     

Aneurysms of the pancreaticoduodenal arteries in association with celiac axis occlusion

Four patients with aneurysms of the inferior pancreaticoduodenal artery are described. All had occlusion of the celiac axis at its origin, with the inferior pancreaticoduodenal arcades serving as a collateral pathway. We propose that the association of the celiac axis occlusion and aneurysms in the collateral supply via the pancreatic arcades is more than coincidental. Awareness of this relationship may be of significance in planning therapeutic intervention