神经介入患者远端桡动脉入路诊疗安全性和可行性

目的 探讨远端桡动脉入路（dTRA）穿刺在神经介入诊疗中的安全性和可行性。方法 回顾性分析2020年10月至2022年3月在北京安贞医院接受dTRA选择性脑血管造影或支架植入术诊疗患者一般资料（年龄、性别、危险因素等）、临床资料（入手术室至穿刺成功时间、手术时间、X线辐射时间、总辐射剂量）、手术相关并发症、穿刺相关并发症。结果 共纳入患者34例,其中男26例,女8例,年龄（61.6±9.0）(33～74)岁。dTRA脑血管造影技术成功率为100%。入手术室至穿刺成功时间为（23.1±10.1）(9～50)min,手术时间为（46.1±27.4）(14～154) min,X线辐射时间为（17.7±12.3）(6～69) min,总辐射剂量为（671.6±334.3）(70～1 573) mGy。造影完成后17例同期接受介入治疗,其中1例椎动脉起始段狭窄患者造影后拟行椎动脉支架植入术,因路径迂曲改为股动脉穿刺。dTRA行介入治疗技术成功率为94.1%(16/17)。术后24 h 1例颈动脉支架植入术患者出现急性支架内闭塞,急诊取栓后美国国立卫生研究院卒中量表（NIHSS）评分为0分。术后患...     

经桡动脉途径前列腺动脉栓塞术可行性及安全性研究

目的 探讨经桡动脉途径前列腺动脉栓塞术(PAE)治疗前列腺增生的可行性及安全性.方法 回顾性分析18例经左侧或右侧桡动脉行C形臂CT引导下PAE术患者临床资料,观察记录上肢动脉痉挛、损伤和穿刺点出血发生率,术后桡动脉搏动及堵塞情况,手指血供及神经损伤情况,手术成功率,围手术期脑血管并发症发生率,手术时间,射线辐射剂量及临床疗效.结果18例患者中接受经左侧桡动脉、右侧桡动脉途径PAE术分别为14例、4例.16例接受双侧栓塞,2例因前列腺动脉开口扭曲伴狭窄仅完成单侧栓塞.术后1例出现桡动脉搏动减弱,超声提示血流减慢.手术时间96～245 min,患者所受辐射剂量2 435～4 958 mGy,平均(3 342±156) mGy,与同期经股动脉途径PAE术差异无统计学意义(P=0.1167).结论采用经桡动脉途径行PAE术安全、可行.     

经桡动脉途径行全脑血管造影的临床应用

目的 评价经桡动脉行全脑血管造影的安全性及有效性,探讨其技术要点、主要优缺点及适应证、禁忌证.方法 对52例不适合经股动脉途径造影或不愿意术后卧床的患者进行经桡动脉全脑血管造影检查(桡动脉组),统计其穿刺成功率、造影成功率及并发症发生率.并与同期进行的83例经股动脉全脑血管造影(股动脉组)结果进行比较.数据分析采用X2检验.结果 两组患者的穿刺成功率、造影成功率及并发症发生率在桡动脉组分别为96.2%(50/52)、94.2%(49/52)、9.6%(5/52),股动脉组分别为100%(83/83)、95.2%(79/83)、8.4%(7/83),两者差异无统计学意义(X2值均为0.000,P值均>0.05).桡动脉组患者发生穿刺部位轻微淤血2例,无血肿、假性动脉瘤和动静脉瘘等严重并发症发生.结论 经桡动脉途径选择性全脑血管造影术安全有效,患者痛苦小、并发症发生率低,可作为脑血管造影的选择途径之一.     

血透通路CT血管成像:80 kV联合低对比剂剂量的可行性

目的 探讨低管电压联合低对比剂剂量扫描技术在上肢血透通路CT血管成像中的可行性.方法 40例体重指数(BMI)≤25 kg/m2的维持性血透患者纳入研究,按检查时间顺序分2组,前20例为A组,80 kVp方案扫描,碘对比剂用量为0.42 gI/kg,后20例为B组,120 kVp方案扫描,对比剂用量为0.525 gI/kg.测量肱骨中段、肘关节以及尺桡骨中段处目标血管和周围肌肉的感兴趣区(ROI) CT值,计算图像的信噪比(SNR)和对比噪声比(CNR),同时记录容积CT剂量指数(CTDIvol)与剂量长度乘积(DLP).2位放射科医师对原始图像和重建图像进行主观质量评分.结果 A组血管区平均CT值(444.65±75.76)HU,显著高于B组的(278.20±42.95)HU(t =7.70,P ＜0.05);A组肌肉区CT值(57.05±7.71)HU,显著高于B组的(51.55±5.81)HU(t=2.325,P ＜0.05);2组间SNR和CNR未见统计学差异.A组的CTDIvol和DLP [(2.87±0.37)mGy,(196.44±28.83) mGy· cm]均显著小于B组(7.86 ±1.61)mGy,(521.14±101.73) mGy· cm(t=-12.380、-12.636,P＜0.05).2位医师主观评分具有较好的一致性(K =0.76,P＜0.05).结论 对于BMI≤25 kg/m2患者,80 kV联合低对比剂剂量成像方案可以获得良好上肢血透通路CTA成像.     

Preoperative evaluation of intracranial aneurysms: usefulness of intraarterial 3D CT angiography and conventional angiography with a combined unit--initial experience

PURPOSE: To assess the usefulness of intraarterial computed tomographic (CT) angiography in conjunction with digital subtraction angiography (DSA) by using a combined CT and angiographic unit in the preoperative evaluation of intracranial aneurysms. MATERIALS AND METHODS: Prospectively, 22 patients with or without subarachnoid hemorrhage underwent CT angiography in conjunction with DSA. Two radiologists independently evaluated DSA and CT angiographic images. Referring neurosurgeons were questioned as to how the additional information provided by CT angiography changed patient treatment. RESULTS: Intraarterial CT angiography was superior to DSA for use in aneurysm detection in three (12%) of 26 aneurysms and for delineation of aneurysm shape, neck, and location in more than half. In 14 (64%) of 22 patients, CT angiography demonstrated 18 additional findings: a very small aneurysm (n = 2), aneurysm shape and neck (n = 6), relationship of the aneurysm to adjacent arteries or bone structure (n = 8), and branches deriving from the aneurysm (n = 2). In four (27%) of 15 patients who underwent surgery or embolization, additional information obtained at CT angiography affected the treatment. CT angiography failed to clearly demonstrate an aneurysm adjacent to bone structures and small perforators, which were derived from the parent artery. CONCLUSION: Intraarterial CT angiography is useful for preoperative evaluation of intracranial aneurysms as a supplement to DSA.     

Repeat angiography in patients undergoing conventional catheter-directed thrombolysis for submassive pulmonary embolism: a large single-center experience

PURPOSEFew studies have examined conventional catheter-directed thrombolysis (CDT) for the treatment of submassive pulmonary embolism (PE). Moreover, angiographic resolution of thrombus burden following CDT has infrequently been characterized. This study describes a single-center experience treating submassive PE with CDT while utilizing repeat angiography to determine treatment effectiveness.METHODSA retrospective analysis of 140 consecutive patients who underwent CDT for submassive PE from December 2012 to June 2019 was performed. Angiographic resolution of thrombus burden after CDT was reported as high (>75%), moderate (51%–75%), low (26%–50%), or insignificant (≤25%). All angiograms were reviewed by two interventional radiologists. Secondary endpoints included reduction in pulmonary artery pressure (PAP) and clinical outcomes. Bleeding events were classified according to the Society of Interventional Radiology (SIR) adverse event criteria.RESULTSCDT was performed in 140 patients with a mean recombinant tissue plasminogen activator (rtPA) dose of 25.3 mg and a mean treatment time of 26.0 hours. Angiographic resolution of thrombus burden was high in 70.0%, moderate in 19.3%, low in 5.7%, and insignificant in 3.6%; in 2 patients (1.4%) repeat angiography was not performed. Systolic PAP was reduced (47 vs. 35 mmHg, p < 0.001), mean PAP was reduced (25 vs. 21 mmHg, p < 0.001), and 129 patients (92.1%) improved clinically. Patients with high or moderate resolution of thrombus burden had a clinical improvement rate of 95.2%, while patients with low or insignificant thrombus burden resolution had a clinical improvement rate of 76.9% (p = 0.011). Ten patients (7.1%) had hemodynamic or respiratory decompensation requiring mechanical ventilation, systemic thrombolysis, cardiopulmonary resuscitation, or surgical intervention. Seven patients (5.0%) experienced moderate bleeding events and one patient (0.7%) with metastatic disease developed severe gastrointestinal bleeding that resulted in death. Thirty-day mortality was 1.4%.CONCLUSIONIn patients with submassive PE undergoing CDT, angiographic resolution of thrombus burden is a safe and directly observable metric that can be used to determine procedural success. In this study, CDT with repeat angiography was associated with a 5.7% bleeding event rate and 30-day mortality of 1.4%.

Pulmonary embolism (PE) is a major cause of morbidity and mortality in the United States, with an estimated 300 000–600 000 cases per year resulting in 100 000–180 000 deaths (1). Among patients with acute PE, there is significant heterogeneity in clinical presentation. Submassive or intermediate-risk PE comprises at least 25% of PE cases and has a 30-day mortality rate of approximately 2%–3% (2–5). Patients with submassive PE have signs of right ventricle (RV) dysfunction demonstrated on imaging studies or elevated cardiac biomarkers (6). Several catheter-directed therapies for submassive PE have been explored, including conventional catheter-directed thrombolysis (CDT), ultrasound-assisted CDT (UACDT), and various types of mechanical thrombectomy.UACDT has been the subject of multiple investigations and is effective in reducing pulmonary artery pressure (PAP) and right ventricular to left ventricular (RV/LV) ratio in patients with submassive or massive PE (7–9). Despite the recent focus on UACDT, conventional CDT remains an effective treatment option and several authors have demonstrated no differences between UACDT and conventional CDT in terms of thrombolytic dose, bleeding complications, PAP reduction, follow-up echocardiographic findings, or mortality (7, 10–12). Mechanical thrombectomy devices are of particular interest in treating PE since they reduce PAP, RV/LV ratio, and thrombus burden with a low risk of bleeding events (13, 14).Currently there is little in the literature to recommend the routine use of CDT for submassive PE, and endpoints evaluating the effectiveness of CDT in this indication have been inconsistent (15). Several studies have used reductions in PAP or RV/LV ratio as endpoints, while others have focused on improvement of clinical symptoms (8, 9, 16–18). The goal of this study was to describe a single-center experience treating submassive PE with conventional CDT while utilizing repeat angiography to determine treatment effectiveness. In addition, this study attempted to contribute to the standardization of terms that describe angiographic resolution of thrombus burden.     

Usefulness of transradial angiography and interventional angiography for abdominal diseases: comparison with transfemoral or transbrachial approach

Transradial angiography has recently emerged as an alternative to the transfemoral or transbrachial approach, especially for coronary or cerebral procedures. However, there are few such studies regarding abdominal angiography. In our institution, we performed abdominal angiography and intervention by the transradial arterial method in 42 cases using a 120-cm-long 4 Fr catheter and compared the results with the transfemoral or transbrachial arterial method and examined the usefulness of this technique. Puncture was successfully carried out in 42 cases, whereas failure occurred in one case, in which the transbrachial method was adopted because of weak pulse. Selective catheter insertion was successful in all cases, after the shape of the catheter had been improved. No serious or dangerous complications occurred during the examinations. In addition, many patients chose the radial arterial method for subsequent examinations on a questionnaire survey we gave patients on the day after we did abdominal angiography by the transradial arterial method. We consider that the transradial arterial method can be used generally in angiography and interventional angiography for abdominal diseases.     

Radiation exposure from conventional and digital subtraction angiography of cerebral vessels

Patients with atherosclerotic cerebrovascular disease were studied to determine the radiation exposure associated with conventional and digital subtraction angiography of the cerebral vessels. The median exposure-area product was 3198 R cm2 (range, 616-5665 R cm2) in the conventional angiography group and 1831 R cm2 (range, 366-4198 R cm2) in the IV digital subtraction angiography (DSA) group. This difference in exposure resulted from increased use of fluoroscopy in the conventional screen-film angiography group. The actual difference in exposure between the radiographic and digital imaging portions of the examinations was much smaller. The contributions of fluoroscopy to the radiation exposure in conventional angiography and IV-DSA in this study were 37% (range, 8.8-76%) and 6% (range, 1.5-25%), respectively.     

1.5T conventional MR-guided iodine-125 interstitial implants for hepatocellular carcinoma: feasibility and preliminary clinical experience

Purpose

To evaluate the feasibility and therapeutic efficacy of 1.5 T conventional MR-guided percutaneous interstitial implantation of I-125 radioactive seeds in patients with hepatocellular carcinoma (HCC).

Materials and methods

The institutional ethics committee approved this study. After imformed consent was obtained, twenty-three patients suffering from a total of 65 HCC lesions were treated with I-125 seed permanent interstitial implantation under the guidance of a 1.5 T conventional magnetic resonance imaging (MRI) system. The FSE T2WI, T1 FSPGR, FIESTA 2D, 3D Dyn T1WI sequences were used to guide an 18G MR-compatible needle inserted into the lesions to introduce the I-125 seeds. The response evaluation criteria in solid tumors (RECIST) were used to evaluate the curative effect.

Results

The needle and I-125 seed were seen clearly on MRI images. The final dose delivered to total decay was 173.46 ± 32.44 Gy (range, 110–270 Gy) as calculated by postoperative TPS. The complete response (CR) was seen in 22 lesions (33.8%), partial response (PR) in 24 lesions (36.9%), stable disease (SD) in 9 lesions (13.8%), and progressive disease (PD) in 10 lesions (15.4%). The post-operative alpha-fetoprotein (AFP) was decreased (t = 3.117, P = 0.005 < 0.05). Two patients were observed a small area of subcapsular bleeding that did not lead to any symptoms or clinical sequelae.

Conclusion

MR-guided I-125 implantation for HCC is technically feasible and effective.     

脑血管成像中减影CTA与常规CTA去骨技术的对照

目的探讨减影CTA去骨技术和常规CTA去骨技术在脑血管成像中重建时间及图像质量的差异。方法回顾性分析30例行脑血管减影CTA和常规CTA检查的患者的资料,后处理重建均用最大密度投影技术(MIP)和容积再现技术(VR),以评价减影CTA和常规CTA图像质量及重建时间。结果减影CTA图像质量优于常规CTA图像质量,且重建时间短于常规CTA。显示血管狭窄及颅底动脉瘤优于常规CTA。结论减影CTA去骨技术用于脑血管成像质量优良,重建血管迅速,显示血管狭窄及颅底动脉瘤优于常规CTA。减影CTA结合曲面重建(CPR)既能显示管腔又能有效的显示动脉管壁情况,弥补了DSA的不足。     

Comparison of magnetic resonance angiography,magnetic resonance imaging and conventional angiography in cerebral arteriovenous malformation

Summary 10 patients with an AVM of the brain were examined by magnetic resonance angiography (MRA), magnetic resonance imaging (MRI) and conventional cerebral angiography (CCA). From MRA in 7/10 patients important information about vascular supply could be provided; in 3 patients, all with small AVM's it could be only suspected. CCA revealed the vascularisation of the AVM's in all patients and showed additional hemodynamic aspects better than MRA. With MRI in all cases the AVM could be diagnosed, but only the involvement of the main cerebral vessels could be demonstrated; however, MRI is superior to MRA and CCA in showing the nidus and the involved brain structures.     

改良法超滑导丝与普通J型导丝在经桡动脉冠状动脉造影中应用对比研究

目的比较经桡动脉途径进行冠状动脉造影时,改良法超滑导丝与普通J型导丝的临床效果。方法选择2014年5月至2016年4月在海军安庆医院行冠状动脉造影检查的患者307例为研究对象。采用随机数字表法将患者分为改良法超滑导丝组(n=153)和普通J型导丝组(n=154)。比较两组患者造影导丝的血管通过性、并发症发生情况以及X线显露时间。结果改良法超滑导丝组152例(99.3%)、普通J型导丝组144例(93.5%)患者导丝成功通过头臂干到达主动脉根部,改良法超滑导丝组的造影导丝的血管通过性优于普通J型导丝组(P<0.05)。两组总并发症、前臂血肿、桡动脉闭塞发生率比较,差异无统计学意义(P>0.05);但普通J型导丝组有6例发生桡动脉痉挛,改良法超滑导丝组未发生,两组桡动脉痉挛发生率比较,差异有统计学意义(P<0.05)。两组在X线显露时间上比较,差异无统计学意义(P>0.05)。结论经桡动脉途径行冠状动脉造影中使用改良法超滑导丝更为安全、有效。     

集64层下肢CT血管成像于一体的全身创伤影像:可行性和初步经验

目的探讨利用64层CT和单一对比剂团注的集下肢CT血管成像于一体的多期全身多发伤的CT扫描方案的影像质量及其临床实用性。材料与方法此回顾性研究通过当地委员会审查,且符合HIPAA。免除知情同意。包含2005年5月—2009年9月期间行包含下肢CT血管成像在     

Intraarterially administered verapamil as adjunct therapy for cerebral vasospasm: safety and 2-year experience

BACKGROUND AND PURPOSE: Despite the widespread use of angioplasty, adjunct chemical therapy is often needed to treat patients with cerebral vasospasm. In this study, we examined the safety of intraarterial administration of verapamil to patients with cerebral vasospasm. We herein summarize our 2-year experience with this treatment. METHODS: We retrospectively reviewed the procedure reports, anesthesia records, clinical charts, and brain images of 29 patients who received intraarterially administered verapamil in 34 procedures for the treatment of vasospasm after subarachnoid hemorrhage from July 1998 to June 2000. The average changes in mean arterial pressure and heart rate were used to measure cardiovascular side effects. The neurologic effects were assessed by angiographic findings, the results of neurologic examinations performed before and after the procedure, and findings of CT of the head. RESULTS: The average dose of verapamil per patient was 3 +/- 0 mg or 44 +/- 5 mcg/kg. The average changes in mean arterial pressure at 10 and 20 minutes were -5 +/- 1 mm Hg and -2 +/- 1 mm Hg or -3.8 +/- 1.0% and -1.7 +/- 1.1%, respectively. No significant change of heart rate was observed at 10 minutes. The patients showed no sign of increased intracranial pressure by hemodynamic parameters, neurologic examination, or CT of the head. On 10 occasions, when the effect of verapamil infusion was assessed angiographically, there was 44 +/- 9% increase of vessel diameter in the spastic segment. Neurologic improvement was noted after five of 17 procedures when verapamil was used as the sole treatment. CONCLUSION: Low dose verapamil is safe when administered intraarterially to patients with cerebral vasospasm. Beneficial effects are achieved in some patients, prompting further study of its efficacy.