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Marfoglio S, Kovarovic B, Hou W, Fiorella DJ, Sadasivan C. An in vitro study of pressure increases during contrast injections in diagnostic cerebral angiography. Interv Neuroradiol 2021; 27:695-702. [PMID: 33631993 DOI: 10.1177/1591019921996099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND During diagnostic cerebral angiography, the contrast bolus injected into a vessel can cause substantial changes in baseline pressures and flows. One potential, and serious complication is the re-rupture of aneurysms due to these injections. The goals of this in vitro study were to evaluate the effect of injection conditions on intraneurysmal pressure changes during angiography. METHODS A silicone replica of a complete circle of Willis model with ophthalmic, anterior communicating, and basilar tip aneurysms was connected to a physiologically accurate flow pump. Contrast injections were performed under different conditions (carotid or vertebral vessel imaging, catheter diameter, injection rate, injection time, and arterial blood flow rate) and the pressure in each aneurysm was recorded before and during each injection. The effect of injection conditions on percentage increase in aneurysm pressures was statistically assessed. Additionally, the effect of the distance between the aneurysm and the catheter-tip on aneurysmal pressures was assessed. RESULTS Mean intraneurysmal pressures during injection (84.5 ± 10.8 mmHg) were significantly higher than pre-injection pressures (80.4 ± 10.6 mmHg, p < 0.0001). Only 3 of the 5 conditions - carotid injections, higher injection rates, and smaller catheter diameters - significantly increased intraneurysmal pressures. The catheter-tip distance showed no correlation to pressure increases. CONCLUSIONS Increasing contrast injection rates and decreasing catheter diameters are correlated to intraneurysmal pressure increases during angiography irrespective of the distance to the catheter tip. Future in vivo studies are required to confirm these findings and determine whether the amplitude of pressure increases with commonly used injection rates can be clinically detrimental.
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Affiliation(s)
- Samantha Marfoglio
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA
| | - Brandon Kovarovic
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA
| | - Wei Hou
- Family, Population and Preventive Medicine, Stony Brook University, Stony Brook, NY, USA
| | - David J Fiorella
- Department of Neurosurgery, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Chander Sadasivan
- Department of Neurosurgery, Stony Brook University Medical Center, Stony Brook, NY, USA
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An H, Park J, Kang DH, Son W, Lee YS, Kwak Y, Ohk B. Should Cerebral Angiography Be Avoided within Three Hours after Subarachnoid Hemorrhage? J Korean Neurosurg Soc 2019; 62:526-535. [PMID: 31484228 PMCID: PMC6732357 DOI: 10.3340/jkns.2018.0238] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 05/09/2019] [Indexed: 11/27/2022] Open
Abstract
Objective While the risk of aneurysmal rebleeding induced by catheter cerebral angiography is a serious concern and can delay angiography for a few hours after a subarachnoid hemorrhage (SAH), current angiographic technology and techniques have been much improved. Therefore, this study investigated the risk of aneurysmal rebleeding when using a recent angiographic technique immediately after SAH.
Methods Patients with acute SAH underwent immediate catheter angiography on admission. A four-vessel examination was conducted using a biplane digital subtraction angiography (DSA) system that applied a low injection rate and small volume of a diluted contrast, along with appropriate control of hypertension. Intra-angiographic aneurysmal rebleeding was diagnosed in cases of extravasation of the contrast medium during angiography or increased intracranial bleeding evident in flat-panel detector computed tomography scans.
Results In-hospital recurrent hemorrhages before definitive treatment to obliterate the ruptured aneurysm occurred in 11 of 266 patients (4.1%). Following a univariate analysis, a multivariate analysis using a logistic regression analysis revealed that modified Fisher grade 4 was a statistically significant risk factor for an in-hospital recurrent hemorrhage (p =0.032). Cerebral angiography after SAH was performed on 88 patients ≤3 hours, 74 patients between 3–6 hours, and 104 patients >6 hours. None of the time intervals showed any cases of intra-angiographic rebleeding. Moreover, even though the DSA ≤3 hours group included more patients with a poor clinical grade and modified Fisher grade 4, no case of aneurysmal rebleeding occurred during erebral angiography.
Conclusion Despite the high risk of aneurysmal rebleeding within a few hours after SAH, emergency cerebral angiography after SAH can be acceptable without increasing the risk of intra-angiographic rebleeding when using current angiographic techniques and equipment.
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Affiliation(s)
- Hong An
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jaechan Park
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Dong-Hun Kang
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Wonsoo Son
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Young-Sup Lee
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Youngseok Kwak
- Department of Neurosurgery, School of Medicine, Catholic University of Daegu, Daegu, Korea
| | - Boram Ohk
- Clinical Trial Center, Kyungpook National University Hospital, Daegu, Korea
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Kovarovic B, Woo HH, Fiorella D, Lieber BB, Sadasivan C. Pressure and Flow Rate Changes During Contrast Injections in Cerebral Angiography: Correlation to Reflux Length. Cardiovasc Eng Technol 2018; 9:226-239. [PMID: 29497965 DOI: 10.1007/s13239-018-0344-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 02/22/2018] [Indexed: 10/17/2022]
Abstract
Cerebral angiography involves the antegrade injection of contrast media through a catheter into the vasculature to visualize the region of interest under X-ray imaging. Depending on the injection and blood flow parameters, the bolus of contrast can propagate in the upstream direction and proximal to the catheter tip, at which point contrast is said to have refluxed. In this in vitro study, we investigate the relationship of fundamental hemodynamic variables to this phenomenon. Contrast injections were carried out under steady and pulsatile flow using various vessel diameters, catheter sizes, working fluid flow rates, and injection rates. The distance from the catheter tip to the proximal edge of the contrast bolus, called reflux length, was measured on the angiograms; the relation of this reflux length to different hemodynamic parameters was evaluated. Results show that contrast reflux occurs when the pressure distal to the catheter tip increases to be greater than the pressure proximal to the catheter tip. The ratio of this pressure difference to the baseline flow rate, called reflux resistance here, was linearly correlated to the normalized reflux length (reflux length/vessel diameter). Further, the ratio of blood flow to contrast fluid momentums, called the Craya-Curtet number, was correlated to the normalized reflux length via a sigmoid function. A sigmoid function was also found to be representative of the relationship between the ratio of the Reynolds numbers of blood flow to contrast and the normalized reflux length. As described by previous reports, catheter based contrast injections cause substantial increases in local flow and pressure. Contrast reflux should generally be avoided during standard antegrade angiography. Our study shows two specific correlations between contrast reflux length and baseline and intra-injection parameters that have not been published previously. Further studies need to be conducted to fully characterize the phenomena and to extract reliable indicators of clinical utility. Parameters relevant to cerebral angiography are studied here, but the essential principles are applicable to all angiographic procedures involving antegrade catheter injections.
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Affiliation(s)
- Brandon Kovarovic
- Department of Biomedical Engineering, Stony Brook University, 102 Bioengineering Building, Stony Brook, NY, 11794-5281, USA
| | - Henry H Woo
- Department of Neurological Surgery, Stony Brook University, HSC T-12, Rm 080, Stony Brook, NY, 11794-8122, USA
| | - David Fiorella
- Department of Neurological Surgery, Stony Brook University, HSC T-12, Rm 080, Stony Brook, NY, 11794-8122, USA
| | - Baruch B Lieber
- Department of Biomedical Engineering, Stony Brook University, 102 Bioengineering Building, Stony Brook, NY, 11794-5281, USA.,Department of Neurological Surgery, Stony Brook University, HSC T-12, Rm 080, Stony Brook, NY, 11794-8122, USA
| | - Chander Sadasivan
- Department of Neurological Surgery, Stony Brook University, HSC T-12, Rm 080, Stony Brook, NY, 11794-8122, USA.
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Crijns CP, Baeumlin Y, De Rycke L, Broeckx BJG, Vlaminck L, Bergman EHJ, van Bree H, Gielen I. Intra-arterial versus intra venous contrast-enhanced computed tomography of the equine head. BMC Vet Res 2016; 12:6. [PMID: 26739315 PMCID: PMC4704255 DOI: 10.1186/s12917-016-0632-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 01/04/2016] [Indexed: 01/02/2023] Open
Abstract
Background The anatomical complexity of the horse’s head limits the abilities of radiography. Computed tomography (CT) in combination with contrast enhanced CT is used more often for diagnosing various head pathology in horses. The objective of this study was to compare intravenous and intra-arterial contrast-enhancement techniques and describe normal and abnormal contrast enhancement in the horse’s head. Results All 24 horses included in the study recovered without complication from the procedures. Compared to the pre-contrast studies, post-contrast studies showed significant contrast enhancement in the pituitary gland (IA: p < 0.0001; IV: p < 0.0001), IA nose septum (p = 0.002), nose mucosa (IA: p < 0.0001; IV: p = 0.02), parotid salivary gland (IA: p < 0.0001; IV p < 0.0001), cerebrum (IA: p < 0.0001; IV: p < 0.0001), rectus capitis muscle (IA: p < 0.0001; IV p = 0.001), IA temporal muscle (p < 0.0001), IA masseter muscle (p <0.0001) and IV brainstem (p = 0.01). No significant contrast enhancement was seen in the eye (IA: p = 0.23; IV p = 0.33), tongue (IA p = 0.2; IV p = 0.57), IA brainstem (p = 0.88), IV nose septum (p = 0.26), IV temporal muscle (p = 0.09) and IV masseter muscle (p = 0.46). Three different categories of abnormal enhancement were detected: a strong vascularised mass, an enhanced rim surrounding an unenhanced structure and an inflamed anatomical structure with abnormal contrast enhancement. Conclusion Using the intra-arterial technique, similar contrast enhancement is achieved using less contrast medium compared to the intravenous technique. And a potential major advantage of the IA technique is the ability to evaluate lesions that are characterized by increased blood flow. Using the intravenous technique, a symmetrical and homogenous enhancement is achieved, however timing is more crucial and the contrast dosage is more of influence in the IV protocol. And a potential major advantage of the IV technique is the ability to evaluate lesions that are characterized by increased vascular permeability. Knowing the different normal contrast enhancement patterns will facilitate the recognition of abnormal contrast enhancements.
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Affiliation(s)
- Casper P Crijns
- Department of Veterinary Medical Imaging and Small Animal Orthopaedics, Ghent University, Faculty of Veterinary Medicine, Merelbeke, Belgium.
| | | | - Lieve De Rycke
- Department of Veterinary Medical Imaging and Small Animal Orthopaedics, Ghent University, Faculty of Veterinary Medicine, Merelbeke, Belgium.
| | | | - Lieven Vlaminck
- Surgery and anaesthesiology of large animals, Ghent University, Merelbeke, Belgium.
| | | | - Henri van Bree
- Department of Veterinary Medical Imaging and Small Animal Orthopaedics, Ghent University, Faculty of Veterinary Medicine, Merelbeke, Belgium.
| | - Ingrid Gielen
- Department of Veterinary Medical Imaging and Small Animal Orthopaedics, Ghent University, Faculty of Veterinary Medicine, Merelbeke, Belgium.
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