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Fluoroscopic Angiography Quantifies Delay in Cerebral Circulation Time and Requires Less Radiation in Carotid Stenosis Patients--A Pilot Study.
Journal of the Chinese Medical Association : JCMA 2019 March 12
BACKGROUND: Quantitative digital subtraction angiography (DSA) facilitates in-room assessment of flow changes in various cerebrovascular diseases, and improves patient safety. The purpose of this study was to compare the diagnostic accuracy of quantitative fluoroscopic angiography (FA) and DSA.
METHODS: Twenty-two patients with more than 70% carotid stenosis according to NASCET criteria were prospectively included. All patients received DSA and FA (ArtisZee, Siemens Healthcare, Forchheim, Germany) before and after carotid stenting in the same angiosuite. The regions of interest (ROIs) included the extracranial internal carotid artery (eICA), first segment of the middle cerebral artery (M1), and sigmoid sinus (SS) in the anterior-posterior (AP) view; cavernous portion of the ICA (cICA), parietal vein (PV), and jugular vein (JV) in the lateral views. The time-to-peak (TTP) for all ROIs and cerebral circulation time (CCT) were measured from FA and DSA scans. TTP, CCT and radiation doses from DSA were compared with those from FA.
RESULTS: The mean age of the patients were 69 ± 9.5 year old. The average stenosis was 89.7 ± 7.8% before stenting and 31 ± 3.6 % after stenting. No patient suffered from periprocedual stroke. The inter-method correlation for TTP for all ROIs except the eICA and cICA ranged from 0.46 to 0.65 before stenting and 0.57 to 0.73 after stenting, and that for CCT was 0.65 before stenting and 0.57 after stenting. The radiation doses were significantly lower for FA than for DSA regardless of views or peri-procedural timing (p <.001).
CONCLUSION: Stenosis facilitated the creation of a bolus by manual injection and therefore increased the accuracy of cerebral flow quantification in FA. Cerebral hemodynamic assessment by FA is quicker and associated with less radiation.This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/).
METHODS: Twenty-two patients with more than 70% carotid stenosis according to NASCET criteria were prospectively included. All patients received DSA and FA (ArtisZee, Siemens Healthcare, Forchheim, Germany) before and after carotid stenting in the same angiosuite. The regions of interest (ROIs) included the extracranial internal carotid artery (eICA), first segment of the middle cerebral artery (M1), and sigmoid sinus (SS) in the anterior-posterior (AP) view; cavernous portion of the ICA (cICA), parietal vein (PV), and jugular vein (JV) in the lateral views. The time-to-peak (TTP) for all ROIs and cerebral circulation time (CCT) were measured from FA and DSA scans. TTP, CCT and radiation doses from DSA were compared with those from FA.
RESULTS: The mean age of the patients were 69 ± 9.5 year old. The average stenosis was 89.7 ± 7.8% before stenting and 31 ± 3.6 % after stenting. No patient suffered from periprocedual stroke. The inter-method correlation for TTP for all ROIs except the eICA and cICA ranged from 0.46 to 0.65 before stenting and 0.57 to 0.73 after stenting, and that for CCT was 0.65 before stenting and 0.57 after stenting. The radiation doses were significantly lower for FA than for DSA regardless of views or peri-procedural timing (p <.001).
CONCLUSION: Stenosis facilitated the creation of a bolus by manual injection and therefore increased the accuracy of cerebral flow quantification in FA. Cerebral hemodynamic assessment by FA is quicker and associated with less radiation.This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/).
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