Extremely tortuous superior cerebellar artery mimicking an aneurysm

Background: An extremely tortuous superior cerebellar artery is a rare anomaly. We report a case of an extremely tortuous superior cerebellar artery mimicking an aneurysm. Case Description: A 77-year-old woman was initially diagnosed with unruptured cerebral aneurysm at the right basilar artery-superior cerebellar artery junction by magnetic resonance angiography. Catheter angiogram revealed that there was no apparent aneurysm at the basilar artery-superior cerebellar artery junction and the lesion was actually an extremely tortuous superior cerebellar artery. Conclusion: Although an extremely tortuous superior cerebellar artery is rare, it should be considered when examining other vascular lesions.

An Enhanced Algorithm for Image Processing Based Catheter Selection During Right Coronary Angiography

Background: Image processing based catheter selection is a newly developed procedure in which a catheter is selected based onpatient's image data, acquired prior to the intervention. In this technique, the arteries are extracted from the data followed by thecomputation of geometric parameters for all available catheters.Objectives: To propose an improved algorithm for estimating geometric parameters such as coronary artery curve angle andlength of the coronary artery curve.Material& Methods: We propose a new framework to compute the geometric parameters from the patient magnetic resonance /computed tomography images. In order to meet the clinical time constraint, we calculate CACA and CACL in 3D MR cardiacimages of the patients.Results: The method has been tested on seven MR cardiac images provided by Unieklinikum Wrzburg. The results show moreaccuracy and less computation time as compared to the already developed method.Conclusion: The proposed algorithm uses an enhanced method for extracting 3D curve to calculate the angle and there by greatlyreduces the computation time and improves the accuracy.Keywords: Optimal catheter; Right coronary angiography; Catheter selection; Landmarks; Geometricparameter

Balloon internal fixation- a novel approach to manipulate catheter knot

Trans-radial approach (TRA) is nowdays a more common approach during percutaneous coronary angiography and intervention. Catheter knot is rare but still a matter of concern for a catheterizing cardiologist. Hence, we describe our case of catheter unknotting using balloon internal fixation of angiography catheter.

Injection of contrast media using a large-bore angiography catheter with a guidewire in place: Physical factors influencing injection pressure in cerebral angiography

Background We have used a contrast injection scheme termed as “guided catheterization method (guided method).” By using a large-bore 5-Fr catheter and 0.032-in guidewire, a contrast medium could be injected without removing the guidewire. Using a neurovascular phantom, we studied the influence of leaving the guidewire on the contrast injection pressure. Image quality was compared with that obtained using a 4-Fr regular angiography catheter (conventional method). Methods Actual contrast injection pressure, flow rate, flow volume, and several variables from the time-density curve (TDC) were obtained using the guided method and the conventional method. Catheterization parameters included flow rate, the viscosity of a contrast medium (CM), and catheter length. The pressure limit of a contrast injector was set as 1200 psi. Digital subtraction angiography (DSA) images on the neurovascular phantom were acquired. The DSA images were processed, and TDC on a specific region of interest was obtained. Variables from TDC were calculated and compared between the different catheters. Results The ranges of actual contrast injection pressure with the conventional and the guided method were 138–299 psi and 184–451 psi, respectively. A minimal reduction of the actual flow rate was found under some conditions with the guided method. Comparable opacifications in DSA images were achieved in all conditions. Although peak intensity was different by flow rate or CM, all TDC variables did not differ based on the catheter. There were no significant harmful events during the 90 experiments. Conclusions With adjustment of the pressure limit, cerebral angiography using the 5-Fr, large-bore catheter without removal of the guidewire is feasible, safe, and expected to provide image quality comparable to that of the 4-Fr regular catheter.

Republished: Novel use of 4D-CTA in imaging of intranidal aneurysms in an acutely ruptured arteriovenous malformation: is this the way forward?

Ruptured arteriovenous malformation (AVM) is a frequent cause of intracranial hemorrhage. The presence of associated aneurysms, especially intranidal aneurysms, is considered to increase the risk of re-hemorrhage. We present two cases where an intranidal aneurysm was demonstrated on four-dimensional CT angiography (time-resolved CT angiography) (4D-CTA). These features were confirmed by digital subtraction angiography (catheter arterial angiogram). This is the first report of an intranidal aneurysm demonstrated by 4D-CTA. 4D-CTA can offer a comprehensive evaluation of the angioarchitecture and flow dynamics of an AVM for appropriate classification and management.

Prospective series of two hours supine rest after 4fr sheath-based diagnostic cerebral angiography: Outcomes, productivity and cost

There is no standard of care for catheter size or post-procedure supine time in cerebral angiography. Catheter sizes range from 4-Fr to 6-Fr with supine times ranging from two to over six hours. The objective of our study was to establish the efficacy, safety, and cost savings of two-hour supine time after 4-Fr elective cerebral angiography. A prospective, single arm study was performed on 107 patients undergoing elective cerebral angiography. All cerebral angiograms were performed with a 4-Fr sheath-based system without closure devices. Ten minutes of manual compression was applied to the femoral access site, with further compression held as clinically indicated. Patients were then monitored in a nursing unit for two hours supine and subsequently mobilized. Nursing discretion was allowed for earlier mobilization. Patients were called the next day to assess delayed hematoma and bleeding. Estimates of cost savings and productivity increases are provided. All patients ambulated in two hours or less. There were no strokes or vessel dissections. Five patients (4.7%) experienced a palpable hematoma, three patients (2.8%) experienced bleeding immediately following the procedure requiring further compression, and one patient (0.9%) experienced minor groin oozing at home. No patient required transfusion, thrombin injection, or endovascular/surgical management of a groin complication. A two-hour post-procedure supine time resulted in cost savings of $952 per angiogram and a total of $101,864. 4-Fr sheath based cerebral angiography with two-hour post-procedure supine time is safe and effective, and allows for a considerable increase in patient satisfaction, cost savings and productivity.

Triple-lumen double-balloon catheter for foam sclerotherapy of the great saphenous vein: critical review on preliminary results

Background Different catheters (angiography, single-balloon) have been used for foam sclerotherapy of the great saphenous vein (GSV). Objective Is there greater efficacy and safety in the use of a double-balloon catheter? Methods Twenty patients were treated with a double-balloon catheter and 3% polidocanol foam. Follow-up after one day, one and six weeks, six and 12 months. Results Up to week six complete success was seen in 95% (19/20) patients. Only eight patients attended the checks after six and 12 months. The occlusion rates were 75% (6/8, 6 months) resp. 50% (4/8, 12 months). A further 10 patients refused these checks as they were free of symptoms but could be questioned. Side-effects were haematoma (100%), limited phlebitis (15%) and one extended thrombophlebitis followed by hyperpigmentation. Conclusion A double-balloon catheter is a safe treatment option for foam sclerotherapy of the GSV. However, in this case series efficacy is not superior to the use of an angiography-catheter, a single-balloon catheter or just the direct puncture of the vein.