Abstract:

Cardiovascular diseases of atherosclerotic genesis are one of the most actual problems of modern medicine. The purpose was to estimate the efficiency of interventional radiology treatment of stenosis and occlusions of arteria iliaca interna et externa (lat.) with self-extracting sten Jaguar SM

95 patients aged 44-79 years (71 male and 34 female) were included into experiment: during the period of 2005-2007 they were underwent nterventional radiology treatment of occlusion-stenosis arteria iliaca defeat. All patients in group had atherosclerotic genesis of disease Minimal length of stenosis was 10 mm, the longest stenosis - 90 mm

All the stenosis were estimated due to TASC II. 10 patients had stenosis type A$ 39 patients - type D, 36 patients - type C, and 10 patients - type D. Endovascular recanalization failed in 5 cases of type D stenosis, and these patients were sent for traditional surgical treatment n 1 case a complication occurred - artery perforation during pre-dilatation, and such problem demanded implantation of stent-graft Afterimplantation balloon dilatation was performed in 95% cases. All patients had angiographycally confirmed restored blood flow. Clinica estimation and angiographycal inspection were spent within 2 years. The inspection in 30 days showed the efficiency 100% in case of stenotic defeat and 80% in case of occlusion defeat. The success rate in 12 month was 87%, in 2 years - 82%.
 

References 

1.    Liapis C.D., Tzortzis E.A. Advances in the management of iliac artery occlusive disease. А short review. Vasc. Endovascular. Surg. 2004: 38 (6): 541-545.

2.    Gray B.H., Sullivan T.M. Aortoiliac occlusive disease. Surgical versus interventional therapy. Cur. Interv. Cardiol. Rep. 2001;3 (2):109-116.

3.    Adam D.J., Bradbury A.W. TASC II document on the management of peripheral arterial disease. Eur. J. Vasc. Endovasc. Surg. 2007; 33 (1): 1-2.

4.    Dotter C.T., Judkins M.P. Transluminal Treatment of arteriosclerotic obstruction. description of a new technic and a preliminary    report    of    its    application. Circulation. 1964; 30: 654-670.

5.    Gruntzig A., Hopff H. Percutaneous recanalization after chronic arterial occlusion with a new dilator-catheter (modification of the Dotter technique) (author's transl). Dtsch. Med. Wochenschr. 1974; 99 (49): 2502-2511.

6.    Palmaz J.C. et al. Expandable intraluminal graft. А preliminary study. Work in progress. Radiology. 1985;156 (1): 73-77.

7.    Mohler E., Giri J. Management of peripheral arterial disease patients. Comparing the ACC/AHA and TASC II guidelines. Cur. Med. Res. Opin. 2008; 24 (9): 2509-2522.

8.    Bosiers M. et al. Present and future of endovascular SFA treatment. Stents, stent-grafts, drug coated balloons and drug coated stents. J. Cardiovasc. Surg. 2008; 49 (2): 159-165.

9.    Lagana D. et al. Percutaneous treatment of complete chronic occlusions of the superficial femoral artery. Radiol. Med. 2008; 113 (4): 567-577.

10.  O'Sullivan G.J. Endovascular management of aorto-iliac occlusive disease. Abdom. Imaging. 2008; 4: 25.

11.  Tsetis D., Uberoi R. Quality improvement guidelines for endovascular treatment of iliac artery occlusive disease. Cardiovasc. Intervent. Radiol. 2008; 31 (2): 238-245.

12.  Kudo T., Chandra F.A., Aim S.S. Long-term outcomes and predictors of iliac angioplasty with selective stenting. J. Vasc. Surg. 2005; 42 (3): 466-475.

13.  Van Walraven L.A. et al. The use of vascular stents in the treatment of iliac artery occlusion. Int. J. Angiol. 2000; 9 (4): 232-235.'

14.  Carreira J.M. et al. Long-term follow-up of symphony nitinol stents in iliac arteriosclerosis obliterans. Minim. Invasive. Ther. Allied. Technol. 2008; 17 (1): 44-42.

15.  Norgren L. et al. Inter society consensus for the management of peripheral arterial disease (TASC II). J. Vasc. Surg. 2007; 45: S5-67.

16.  Diehm N. et al. TASC II section E3 on the treatment of acute limb ischemia. Commentary from European interventionists. J. Endovasc. Ther. 2008; 15 (1): 126-128.

17.  Mousa A.Y. et al. Endovascular treatment of iliac occlusive disease. Review and update. Vascular. 2007; 15 (1): 5-11.

18.  Karwowski J., Zarins C.K. Endografting of the abdominal aorta and iliac arteries for occlusive disease. J. Cardiovasc. Surg. 2005; 46 (4): 349-357.

19.  Sasaki Y. et al. Stenting for superficial femoral artery atherosclerotic occlusion. Long-term follow-up results. Heart. Vessels. 2008; 23 (4): 264-270.

20.  Sapoval M.R. et al. Self-expandable stents for the treatment of iliac arter. Am. J. Roentgenol. 1996; 166 (5): 173-1179.

21.  Sixt S. et al. Acute and long-term outcome of endovascular therapy for aortoiliac occlusive lesions stratified according to the TASC classification. А single-center experience. J. Endovasc. Ther. 2008; 15 (4): 408-416.

22.  Zana K. et al. Risk of embolism in diagnostic and therapeutic intravascular procedures - in vitro model. Orv. Hetil. 2001; 142 (34): 1837-1841.

23.  Zana K. et al. In vitro evaluation of the embolic risk of diagnostic and therapeutic intravascular procedures. Med. Sci. Monit. 2001; 7 (1): 148-152.

24.  Saratzis A. et al. Pharmacotherapy before and after endovascular repair of abdominal aortic aneurysms. Cur. Vasc. Pharmacol. 2008; 6 (4): 240-249.

25.  Harnek J. et al. Insertion of self-expandable nitinol stents without previous balloon angioplasty reduces restenosis compared with PTA prior to stenting. Cardiovasc. Intervent. Radiol. 2002; 25 (5): 430-436.

Abstract:

Purpose. Was to compare beam loading and quality of coronary arteries’ imaging (CA) in case of using the 64-lise computed tomography (MSCT) in retro-and prospective electrocardiographic synchronization mode.

Materials and methods. 57 patients with coronar arteries disease suspicious were examined with the help of computed tomography (CT) coronarography in prospective (n = 27) and retrospective (n = 30) EKG-synchronization modes. All the experiments were held on multislice Discovery CT 750 MD («General Electric»). The quality of obtained CR images was estimated subjectively – from 1 (perfect quality) to 4 (non-

diagnostic).

Results. The analyses of obtained images during retro-and prospective EKG-synchronization did not reveal serious differences (1,4 ± 0,38

and 1,5 ± 0,46 accordingly). The effective dose during prospective EKG-synchronization was 59% less than during retrospective EKG-synchronization (3,8 ± 0,83 mSv and 9,3 ± 2,5 mSv, р < 0,05).

Conclusion. CT-coronarography in prospective EKG-synchronization mode leads to essential decrease in beam loading on the patient without deterioration of the received image quality.  

References 

1.    Gaemperli O. et al. Accuracy of 64-slice CT angiography for the detection of functionally relevant coronary stenoses as assessed with myocardial perfusion SPECT. Eur. J Nucl. Med. Mol. Imaging. 2007; 34: 1162–1171.

2.    Mollet N.R. et al. High-resolution spiral computed tomography coronary angiography in patients referred for diagnostic conventional coronary angiography. Circulation. 2005; 112: 2318–2323.

3.    Raff G.L. et al. Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography. J. Am. Col. Cardiol. 2005; 46: 552–557.

4.    Scheffel H. et al. Accuracy of dual-source CT coronary angiography. First experience in a high pre-test probability population without heart rate control. Eur. Radiol. 2006; 16: 2739–2747.

5.    Husmann L. et al. Comparison of diagnostic accuracy of 64-slice computed tomography coronary angiography in patients with low, intermediate and high cardiovascular risk.

6.    Acad. Radiol. 2008; 15: 452–461. Leschka S. et al. Low kilovoltage cardiac dual-source CT. Аttenuation, noise, and radiation dose. Eur. Radiol. 2008; 18: 1809–1817.

7.    Hausleiter J. et al. Radiation dose estimates from cardiac multislice computed tomography in daily practice. Impact of different scanning protocols on effective dose estimates. Circulation. 2006; 113: 1305–1310.

8.    Husmann L. et al. Feasibility of low-dose coronary CT angiography. First experience with prospective ECGgating. Eur. Heart. J. 2008; 29:191–197.

9.    Herzog B.A. et al. Accuracy of low-dose computed tomography coronary angiography using prospective electrocardiogram triggering. First clinical experience. Eur. Heart. J. 2008; 29: 3037–3042.

10.  Husmann L. et al. Diagnostic accuracy of computed tomography coronary angiography and evaluation of stress-only single-photon emission computed tomography / computed tomography hybrid imaging. Сomparison of prospective electrocardiogram-triggering vs. retrospective gating. Eur. Heart. J. 2009; 30:600–607.

11.  Hsieh J. et al. Step-and-shoot data acquisition and reconstruction for cardiac x-ray computed tomography. Med. Phys. 2006; 33:4236–4248.

12.  Earls J.P. et al. Prospectively gated trans-verse coronary CT angiography versus retrospectively gated helical technique. Improved image quality and reduced radiation dose. Radiology. 2008; 246: 742–753.

13.  Shuman W.P. et al. Prospective versus retrospective ECG gating for 64-detector CT of the coronary arteries.