Time-resolved contrast-enhanced MR angiography of renal artery stenosis: diagnostic accuracy and interobserver variability

OBJECTIVE

The purpose of this study was to evaluate diagnostic accuracy and interobserver variability of time-resolved three-dimensional gadolinium-enhanced MR angiography in the detection of renal artery stenosis in comparison with intraarterial digital subtraction angiography as the standard of reference.

SUBJECTS AND METHODS

Forty consecutive patients (age range, 25-81 years; mean, 62.9 +/- 11.9 years) with suspected renal artery stenosis underwent intraarterial digital subtraction angiography and gadolinium-enhanced MR angiography, performed on a 1.5-T system with fast low-angle shot three-dimensional imaging (3.8/1.49 [TR/TE], 25 degrees flip angle, 10-sec acquisition time, and 1.5-mm partition thickness). Three time-resolved phases were obtained in a single breath-hold. Digital subtraction angiography and gadolinium-enhanced MR angiography were evaluated by four observers who studied 80 main renal arteries and 19 accessory vessels to evaluate the degree of stenosis. A stenosis reducing the intraarterial diameter by more than 50% was regarded as hemodynamically significant. Interobserver variability was calculated.

RESULTS

Only one gadolinium-enhanced MR angiography study was not of diagnostic quality, as a result of failure of the power injector. All main branches were of diagnostic quality in 38 (97.4%) of the remaining 39 gadolinium-enhanced MR angiography studies. Seventeen (89.5%) of 19 accessory renal arteries were depicted with gadolinium-enhanced MR angiography. The overall sensitivity for significant stenoses was 92.9%. The overall specificity was 83.4%, and the overall accuracy was 85.9%. Interobserver variability of gadolinium-enhanced MR angiography exceeded that of digital subtraction angiography.

CONCLUSION

Time-resolved three-dimensional gadolinium-enhanced MR angiography is a useful noninvasive method of screening suspected renal artery stenosis because of its easy application, short examination time, and high sensitivity despite of its higher interobserver variability.

[Digital subtraction angiography of the extremities using step-translation technique]

PURPOSE

To evaluate, how routine application of i.a. DSA with the step-translation technique using a single contrast bolus can effectively reduce radiation exposure and the amount of contrast media in comparison to standard peripheral DSA.

METHOD/MATERIALS

100 patients with peripheral arterial occlusive disease were assessed with step-translation DSA, 100 with standard DSA using the same equipment. Imaging quality was rated two observers, judgement by consensus. Comparison of the technical data (radiation dose, contrast media) was based on pairs of patients with similar constellations of stenoses to reduce selection bias.

RESULTS

Step-translation DSA was of high imaging quality from the iliac vessels to the popliteal artery. In the distal leg, imaging was often impaired by effects like unilaterally delayed contrast flow due to high grade stenosis or motion artifacts. 53% of the step translation DSA required 1 or 2, 29% more than two additional DSA runs. Including the additional runs, the average radiation exposure and the amount of contrast media (2434 cGycm2/128 ml) were comparable to those of standard DSA (2461 cGycm2/144 ml).

CONCLUSIONS

Step-translation DSA provides high quality images. In routine application realization of the advantages over standard DSA such as reduction of examination times, radiation exposure and amounts of contrast media may be impaired by poorly collateralized stenoses or motion artifacts demanding additional series.

[Volume-artifact reduction technique by spiral CT in the anterior, middle and posterior cranial fossae. Comparison with conventional cranial CT]

PURPOSE

The object of this study was to determine the extent to which a new volume-artifact reduction (VAR) modality using helical CT was able to reduce artifacts in the anterior, middle and posterior fossae in comparison with conventional CT (sequential mode).

METHODS

In a prospective, randomized trial, 50 patients underwent helical CT (VAR) and 50 underwent sequential CT. The results were evaluated by three radiologists; influences on image quality where scaled between 1 (no artifact) and 4 (not assessable). Eight regions of the anterior, middle and posterior fossae were evaluated.

RESULTS

On average, artifacts were scaled at 2.5 in helical CT (VAR) and 3.1 in conventional CT. Significant differences were seen at the eyeball, anterior to the petrosal bone, at the internal occipital crest, and at the level of the transverse sinus (p < 0.005).

CONCLUSIONS

Helical CT with the VAR modality is superior to conventional, sequential CT in the area of the anterior, middle and posterior fossae.

[CT-guided biopsies, drainage and and percutaneous gastrostomies: comparison of punctures with and without CT fluoroscopy]

PURPOSE

The purpose of this prospective and randomized study was to compare two CT guidance techniques (CT-fluoroscopy/conventional CT) on percutaneous biopsies, drainages and gastrostomies.

MATERIAL AND METHODS

78 CT-guided interventions (29 biopsies, 38 drainages, 8 gastrostomies) were recorded and the Mann-Whitney U-test was applied. In 3 cases both guidance techniques were used. Procedure times, yields and radiation doses were analyzed.

RESULTS

All 38 drainages and all 8 gastrostomies were successfully applied. 13 biopsies with conventional CT guidance (n = 15) and 13 biopsies with CT-fluoroscopy (n = 14) showed a representative histopathologic result. The procedure times were not significantly different (drainages: p = 0.658, biopsies: p = 0.431, gastrostomies: p > 0.06). The radiation doses (CTID1) of the biopsies and drainages showed significantly higher values (drainages p < 0.001, biopsies p < 0.001) with CT-fluoroscopy than with conventional CT. There were no significant differences in gastrostomy procedures (p > 0.06).

CONCLUSION

Procedure times and yields were not improved by using CT-fluoroscopy. Radiation doses showed significantly higher values with CT-fluoroscopy than with conventional CT guidance. CT-fluoroscopy was advantageous in non-compliant patients over conventional CT guidance.

[Stent angioplasty of pelvic artery stenosis with MRI control: initial clinical results]

PURPOSE

To investigate the feasibility of MR-guided stent angioplasty of iliac artery stenoses under passive visualization.

MATERIAL AND METHODS

Three patients with short, concentric stenoses of the iliac arteries were enrolled. The vascular interventions were performed on a 1.5 T MR scanner (Magnetom Symphony, Siemens, Erlangen, Germany). Stents, guidewires, and balloon catheters were visualized on the basis of susceptibility artifacts. Contrast-enhanced MR angiography (ceMRA) was used to localized the stenosis prior to stent deployment. Nitinol stents were placed under MR-guidance using a fast 2D gradient echo technique. Balloon dilatiation was performed with an angioplasty catheter inflated with diluted gadolinium-DTPA. Postinterventional results were evaluated by ceMRA, DSA, and Doppler indices.

RESULTS

Position of the stent, stent deployment, and balloon dilatation were depicted by MR. All stents were correctly placed within the stenosis. Stent positions as monitored by MRI were identical to those seen on DSA images. All patients were treated successfully by the MR-guided intervention.

CONCLUSION

An MR-guided stent angioplasty of simple iliac artery stenosis is feasible under passive visualization.

[Contrast medium-enhanced MR angiography of the pelvic and leg vessels with an automated table-feed technique]

PURPOSE

To evaluate contrast enhanced magnetic resonance angiography (ceMRA) with an automated table-feed technique in patients with arterio-occlusive disease for imaging of the pelvic and peripheral arteries.

METHODS

Twenty-two patients underwent three-dimensional gadolinium-enhanced MR angiography in a three-step automatic table-feed technique on a Magnetom Symphony operating at 1.5 Tesla. Maximum intensity projection images (MIP) were generated from the subtracted and original studies. Image quality and venous contrast were evaluated by two groups of observers. 304 vessels (17 patients) were compared with DSA as the standard of reference.

RESULTS

All examinations were performed without any technical problems. Diagnostic quality of the MIP of subtracted data sets was superior to that of the unsubtracted images. Venous overlay was 61% in the lower leg. In a total of 599 observations, a sensitivity of 96% (95%, 82%) and a specificity of 87% (88%, 99%) were high compared to DSA in the detection of significant stenoses > or = 50% (> or = 75%, occlusions). Interobserver correlation was good (linear correlation 0.9).

CONCLUSION

Stepping-table digital subtraction contrast enhanced MRA is a promising technique in the diagnosis of peripheral arterio-occlusive disease.

[Rotational digital subtraction angiography of carotid bifurcation stenosis]

PURPOSE

A prospective study was designed to evaluate, whether multiplanar imaging with rotational digital subtraction angiography (R-DSA) could improve assessment of carotid artery bifurcation stenosis.

PATIENTS AND METHODS

45 patients with suspected stenosis of the ICA were examined with DSA in standard projections (0 degree-(45 degrees)-90 degrees) and additional R-DSA of each ICA from 0-90 degrees in 10 degrees steps. We compared imaging quality and degree of stenosis as well as exposure of the patients to radiation and contrast media.

RESULTS

79/82 R-DSA (96%) were suitable for evaluation of stenosis, 58/82 (70%) matched the quality standard of single projection DSA. Specificity and sensitivity of the R-DSA to diagnose high grade ACI stenosis were 100% and 94%, respectively. 7/79 R-DSA revealed a higher and 3/79 a lower degree of stenosis than the corresponding DSA. Regarding the degree of stenosis there was no significant difference between the two modalities (p > 0.05), but R-DSA detected 4 stenoses greater than 60% that were estimated to be lower than 60% by DSA. Radiation dose for R-DSA was equivalent to one DSA run (170 cGycm2). The average amount of contrast media (25 ml) was slightly higher than for 2-3 single-projection DSA (19.8 ml).

CONCLUSIONS

R-DSA provides high quality imaging of the carotid bifurcation with multiplanar projections facilitating exact grading of vessel stenosis. The number of cases (n = 2) is to small to judge the value of R-DSA as to (tandem-) stenosis of the distal ICA. Still, diagnostic value and low radiation exposure justify the use of R-DSA as additional series to standard protocols.

Iliofemoral arterial occlusive disease: contrast-enhanced MR angiography for preinterventional evaluation and follow-up after stent placement

PURPOSE

To evaluate the efficacy of contrast material-enhanced magnetic resonance (MR) angiography for the diagnosis of peripheral arterial occlusion and follow-up after stent placement.

MATERIALS AND METHODS

Sixty-seven patients (21 women, 46 men; mean age, 64.6 years) were examined. Digital subtraction angiography and contrast-enhanced MR angiography were performed in 28 patients for preinterventional evaluation of iliofemoral arterial occlusion and in 39 patients for follow-up after stent placement in the iliac or femoral arteries, which had been performed several months before.

RESULTS

All 24 occlusions were correctly diagnosed with contrast-enhanced MR angiography. Of the 59 stenoses, 36 were greater than 50% and 23 were 50% or less. Sensitivity and specificity for the detection of stenoses greater than 50% were 100% and 83%, respectively. Patency of the different stents was determined correctly with contrast-enhanced MR angiography. Some stents caused signal intensity dropout, which made MR evaluation of stents difficult. Generally, these signal intensity artifacts were most severe in stainless steel stents and mild in some nitinol stents.

CONCLUSION

Contrast-enhanced MR angiography is comparable to digital subtraction angiography for the detection of stenosis greater than 50% and occlusion in the iliofemoral arteries. Stent patency can be determined, but contrast-enhanced MR angiography is not suitable for stent evaluation owing to signal intensity dropout; however, it provides information about the vascular anatomic areas proximal and distal to the stent.

[Digital 3D rotational angiography for the preoperative and preinterventional clarification of cerebral arterial aneurysms]

OBJECTIVE

Does the recently introduced 3D angiography provide additional information beyond standard angiography (DSA) for the diagnosis of cerebral aneurysms?

METHODS

During a 3-months period DSA and 3D-angiography were performed in 40 patients harbouring a total of 49 aneurysms. Vascular regions that presented an aneurysm diagnosed by DSA were reevaluated by 3D-angiography.

RESULTS

In two patients, vessel-loops previously described as aneurysms by DSA could be identified by 3D-angiography. In one patient, an aneurysm was diagnosed that could not be detected by DSA. In another case, the definitive diagnosis of an aneurysm was obtained only with 3D-angiography. In one patient, an aneurysm was diagnosed that could not be detected by DSA. In another case, the diagnosis of an aneurysm was obtained only with 3D-angiography. In two cases, aneurysms could be definitively excluded by 3D-angiography, whereas in another aneurysm a vessel originating from this lesion was identified. The size of the aneurysms measured by both methods was identical.

CONCLUSIONS

Multiple projections of 3D-angiography provide a better evaluation of the anatomic situation regarding the base of the aneurysm as well as the relationship of an aneurysm to neighbouring vessels. Further, an exact differentiation between a vessel loop and an aneurysm can be made. Therefore, 3D-angiography is a valuable tool when used in conjunction with DSA.

A phase I study of a HER2/neu bispecific antibody with granulocyte-colony-stimulating factor in patients with metastatic breast cancer that overexpresses HER2/neu

A phase I study of escalating doses of humanized bispecific antibody (bsAb) MDX-H210 with granulocyte-colony-stimulating factor (G-CSF) was conducted in patients with metastatic breast cancer that overexpressed HER2/neu. The main objectives of the study were to define the maximal tolerated dose (MTD) of MDX-H210 when combined with G-CSF, to measure the pharmacokinetics of MDX-H210 when administered with G-CSF, and to determine the toxicity, biological effects and possible therapeutic effect of MDX-H210 with G-CSF. MDX-H210 is a F(ab)' x F(ab)' humanized bispecific murine antibody that binds to both HER2/neu and the FcgammaR1 receptor (CD64), and was administered intravenously weekly for three doses followed by a 2-week break and then three more weekly doses. A total of 23 patients were treated, and doses were escalated from 1 mg/m2 to 40 mg/m2 with no MTD reached. The toxicity of the bsAb + G-CSF combination was modest, with no dose-limiting toxicity noted: 19 patients had fevers, 7 patients had diarrhea, and 3 patients had allergic reactions that did not limit therapy. The beta-elimination half-life varied from 4 h to 8 h at doses up to 20 mg/m2. Significant release of cytokines interleukin-6, G-CSF, and tumor necrosis factor alpha was observed after administration of bsAb. Circulating monocytes disappeared within 1 h of bsAb infusion, which correlated with binding of bsAb, noted by flow-cytometric analysis. Significant levels of human anti-(bispecific antibody) were measured in the plasma of most patients by the third infusion. No objective clinical responses were seen in this group of heavily pre-treated patients.

Percutaneous endoluminal stent and stent-graft placement for the treatment of femoropopliteal aneurysms: early experience

PURPOSE

To determine the efficacy of percutaneous endoluminal stents and stent-grafts for the treatment of isolated femoropopliteal aneurysms.

METHODS

Seven men (age 51-69 years) with femoropopliteal occlusions (n = 6) related to aneurysms and a patent femoropopliteal aneurysm (n = 1) were treated percutaneously. In two patients uncovered Wallstents and in five patients polyester-covered nitinol stents were implanted. Assessment was performed with Doppler ultrasound and duplex ultrasonography 24 hr, 1, 3, 6, 12, and 24 months after the intervention. Additionally, intraarterial angiography was performed at 6 months.

RESULTS

Stent placement succeeded in all cases. No immediate adjunctive surgical treatment was necessary. Ankle-brachial index (ABI) improved from 0.29 +/- 0. 29 (SD) before to 0.78 +/- 0.23 (SD) 24 hr after the intervention. One patient was lost to follow-up. Stent-graft occlusion occurred in four patients: after 2 days (n = 1), 1 month (n = 2), and 3 months (n = 1). One of the patients, whose stent occluded at 1 month, underwent successful recanalization with local fibrinolysis therapy. Three of the seven, all with three-vessel run-off, demonstrated patency of the stent, which was assessed by duplex ultrasonography at 29, 31, and 34 months. Breaking of the stent struts or significant stent migration was not observed.

CONCLUSIONS

These results in a small number of patients warrant further investigation to evaluate the role of percutaneous stents in femoropopliteal aneurysms. Until further data of clinical studies are available, this method cannot be recommended, and it cannot replace surgical treatment.

Lower extremity occlusive disease: diagnostic imaging with a combination of cardiac-gated 2D phase-contrast and cardiac-gated 2D time-of-flight MRA

PURPOSE

The goal of this work was to test the ability of a combination of 2D phase-contrast MR angiography (2D-PC-MRA) and triggered 2D time-of-flight MRA (2D-TOF-MRA) in comparison to intraarterial digital subtraction angiography (DSA) to correctly diagnose the location and shape of occlusive lesions in the iliac and femoral arteries and to determine whether 2D-TOF-MRA is helpful to clarify questionable lesions demonstrated by 2D-PC-MRA.

METHODS

In 50 patients with claudication, 2D-PC-MRA was performed in three consecutive coronal positions from the aortic bifurcation to below the trifurcation. Axial 2D-TOF-MRA was performed additionally at the site of detected lesions of >50% and lesions in doubt to obtain more precise information about the stenosis. Lesions were classified as follows: low grade occlusion, <50%; high grade occlusion, >50%. MRA was performed within 24 h of a DSA examination.

RESULTS

In all patients, the arterial tree from the aortic bifurcation to the trifurcation could be visualized. One hundred twelve lesions were detected by MRA. Sensitivity was 96% and specificity was 92%. Sixty-two lesions were classified as high grade occlusion and reevaluated. In this category, sensitivity was 100% and specificity was 96%.

CONCLUSION

The combination of 2D-PC-MRA with triggered 2D-TOF-MRA detects stenotic lesions in the lower extremity arterial system with high sensitivity and specificity.

The utility of contrast-enhanced MR-angiography for posterior fossa giant cerebral aneurysm management

The utility of magnetic resonance angiography is sometimes limited in the diagnostic workup of cerebral aneurysms with low flow and/or partial thrombosis when weighed against digital subtraction angiography. We present the case of a rare superior cerebellar artery giant, partially thrombosed aneurysm in which additional i.v. contrast-enhanced MRA sequences were comparable to digital subtraction angiography. It demonstrated not only the exact spatial resolution and correct anatomical relation but also the hemodynamics which were confirmed by intraoperative Doppler ultrasound. This report supports the feasibility and utility of i.v. contrast-enhanced MRA for posterior fossa giant cerebral aneurysm management.

Intracerebral hemorrhage as a late complication after CNS treatment of childhood lymphoma

Since the majority of children with acute leukemia and lymphoma are long-term survivors, more attention is directed towards late sequelae of therapy. Intracerebral hemorrhage after treatment of central nervous system (CNS) neoplasia in childhood is a very rare event. A seven and a half-year-old boy was admitted to our hospital because of acute third nerve palsy. Three years and eight months before the patient had been treated for a mediastinal T-cell non Hodgkin's lymphoma (T-NHL) with CNS involvement by combined chemo-radiotherapy. Recurrent disease was excluded, but intracerebral hemorrhage in the tectal area was demonstrated by repeated magnetic resonance imaging. Symptoms of incomplete oculomotor paresis improved spontaneously with conservative therapy. Intracerebral hemorrhage may occur as a rare complication in children with malignant CNS disease even years after treatment with combined chemo-radiotherapy.

[Contrast-enhanced MR angiography in Leriche's syndrome]

PURPOSE

To determine the usefulness of contrast-enhanced MR angiography for the diagnosis of Leriche's syndrome.

MATERIAL AND METHODS

Leriche's syndrome was seen in 7 patients via DSA. In addition, contrast-enhanced MR angiography was performed (TR 7.8 ms/TE 2.1 ms, flip angle 30 degrees, slab thickness 116 mm, slice thickness 1.82 mm, 64 partitions, FOV 500 x 438 mm, matrix 224 x 512).

RESULTS

Diagnosis of Leriche's syndrome was possible by contrast-enhanced MR angiography in each case. Visualisation of the femoral arteries was not possible in two patients by intraarterial DSA, in three other patients there was an insufficient contrast in the femoral arteries with DSA. Contrast-enhanced MR angiography revealed good visualisation of the femoral arteries in these patients. In addition, contrast-enhanced MR angiography allowed complete visualisation of the patent lower limb arteries. In intraarterial DSA visualisation of the lower limb arteries was achieved reached in only one patient, but was incomplete.

CONCLUSION

Contrast-enhanced MR angiography yielded the correct diagnosis of Leriche's syndrome in all 7 patients. Contrast-enhanced MR angiography was superior to DSA in the assessment of the distal run-off vessels in five of seven patients.

MRI features of craniofacial fibrous dysplasia

A 13-year-old female with a 4-year history of monostotic fibrous dysplasia had noticed a progressive proptosis of the right eye and diplopia on upward gaze for 4 weeks. A few years previously an incisional biopsy of the skull had verified the presumed diagnosis of fibrous dysplasia with recurrent bleeding into pathologic cystic bony structures of the skull. The patient was known to have craniofacial fibrous dysplasia with involvement of the frontal and intermediate cranial base, the posterior ethmoidal labyrinth, and the sphenoidal and maxillary sinuses. Eye examination showed a reduced visual acuity in the right eye without defects of the visual field. MR imaging showed a fluid-filled cystic cavity in the orbital frontal bone pushing the globe downwards. Four months later she developed similar symptoms on the other side while proptosis of the right eye was regressive. T2-weighted MRI revealed a large fluid-filled cystic cavity with a fluid-fluid level in the upper part of the left orbit. It is concluded that follow-up studies can be easily performed by MRI without additional exposure to radiation. The total extent of osseous involvement can be determined. Thus, MRI may be helpful in deciding between operative or conservative therapy.

[Treatment of arterial femoropopliteal obstructions with Palmaz midsize stents]

PURPOSE

To evaluate effectiveness, success and patency rates after endovascular treatment with mid-size Palmaz stents in high-grade stenoses or short-distance occlusions of femoral arteries.

MATERIALS AND METHODS

27 patients with 10 occlusions (average length 3.2 +/- 1.4 cm) and 17 severe stenoses of the superficial femoral artery were treated with 33 mid-size Palmaz stents. The follow-up included Doppler ultrasound at one, three, 6 and 12 months and an angiography at 6 months. Mean follow-up was 6.5 months.

RESULTS

Technical success was 100%. The ankle-brachial index improved from 0.57 +/- 0.28 pretreatment to 0.87 +/- 0.13 within 24 hours. Acute stent thrombosis occurred in two patients (< 3 weeks). Angiography at 6 months revealed restenosis rates of 7.4% (> 50%, n = 2). Life-table analysis according to Kaplan-Meier revealed 6-month primary and secondary patency rates of 84% and 91%.

CONCLUSION

With regard to our limited data, the implantation of mid-size Palmaz stents in femoral arteries seems promising in treatment of short-distance occlusions and stenoses of the femoral artery.

[PTA of the brachiocephalic arteries]

PURPOSE

Assessment of the technical success and mid-term success of PTA of brachiocephalic occlusive disease.

MATERIAL AND METHODS

24 patients, who were treated interventionally because of stenoses of the brachiocephalic arteries were enrolled into this prospective study. In total there were 27 lesions (26 arteriosclerotic lesions and one dissection with pseudoaneurysma). 18 lesions were located in the subclavian artery (extending into the axillar artery in one case), 4 in the brachiocephalic trunk, three in the common carotid artery and two in the vertebral artery. As adjunctive to balloon dilatation 8 stents were implanted.

RESULTS

Technical success was achieved in 24/27 lesions. There was an embolic complication in one of 27 interventions. 15/24 patients with 17 treated lesions underwent control angiography with a mean follow-up of 14 months. Follow-up angiography revealed one occlusion and three significant restenoses. 5/24 patients agreed only to clinical follow-up and Doppler examinations, three were lost and one patient died.

CONCLUSION

PTA of brachiocephalic occlusive disease showed good technical success. Additional implantation of stents may be useful. Midterm success is satisfactory.

[Minimal invasive therapy of aneurysms of the superficial femoral artery and the popliteal artery]

Percutaneous stent placement has been described for treatment of aneurysms as an alternative to surgical therapy. Literature reports of percutaneous minimal invasive therapy of peripheral aneurysms shall be reviewed and compared with our own results. Six male patients (51-69 years) with femoropopliteal occlusions related to aneurysms were treated percutaneously. In two cases Wallstents and in four cases polyester-covered nitinol stents were applicated. A clinical investigation including doppler-ultrasound was performed 24 hrs, 1, 3, 6, 12 and 24 months after the intervention. Stent placement succeeded in all cases. No adjunctive surgical treatment was necessary. Ankle-brachial-index (ABI) improved from 0.22 +/- 0.2 before to 0.74 +/- 0.2 24 hours after the intervention. One patient was lost for follow-up (Wallstent). A decrease of ABI and additional intraarterial angiography revealed stent-graft occlusion within one month (n = 2) and within three months (n = 1). One of these cases was successfully recanalized with local fibrinolysis therapy. In three patients patency of the stent persisted for 24 (+/- 2) months follow-up with three-vessel-supply of the calf. These results warrant further investigations for this minimal invasive method of percutaneous stent deployment as an alternative to surgical bypass treatment of femoropopliteal aneurysms. Time of hospitalization was reduced. At this time, surgical treatment of peripheral vascular aneurysms is gold standard.

[Midterm follow-up after Cragg stent placement in iliac arteries]

PURPOSE

Evaluation of midterm success and patency rates after placement of Cragg stents in iliac arteries.

MATERIAL AND METHODS

During a period of 26 months 16 patients, with a total of 19 iliac lesions were treated percutaneously by placement of 20 stents. Indications of stent placement were iliac occlusion in 4 cases and high-grade iliac stenoses in 15 cases. Indication for stent placement in the stenotic lesions were insufficient results following balloon angioplasty in 11 cases and extensive dissection in 4 cases.

RESULTS

The ankle-brachial index was improved from 0.53 +/- 0.28 to 0.85 +/- 0.26 immediately after the intervention and was 0.80 +/- 0.15 at 16 months follow-up. Cumulative patency rate was 71% after 12 months.

CONCLUSION

The occlusion and restenosis rates are high. Disadvantages of Cragg stents are low flexibility and a large bore introducer system. The radiopacity of the Cragg stent is advantageous for fluoroscopic positioning.