Patients’ Radiation Doses During the Implantation of Stents in Carotid, Renal, Iliac, Femoral and Popliteal Arteries

AbstractObjectives and DesignThe aim of the study was to document the radiation doses to patients during the implantation of stents in various arteries and to discuss potential reasons for prolongation of radiological procedures.Materials and MethodsMeasurements of air kerma (Gy) and dose–area product (Gy cm2) (DAP) were carried out simultaneously on a sample of 345 patients, who underwent different interventional radiological procedures involving angioplasty with stenting of 73 carotid (21.5%), 22 renal (6.5%), 160 iliac (45%), 63 femoral (18.6%) and 27 popliteal (7.9%) arteries.ResultsThe highest mean air kerma values for fluoroscopy and exposure were found for renal angioplasty (340 and 420 mGy, respectively). With regard to total DAP values, the highest were obtained for renal (148 Gy cm2) and iliac/The Inter-Society Consensus for Management of Peripheral Arterial Disease (TASC) II C (199 Gy cm2) stent implantation. The lowest values were for carotid (53 Gy cm2), iliac/TASC II A (6.3 Gy cm2) and femoral/TASC II A (53 Gy cm2) arteries. For 3.5% of the patients, the air kerma was between 1 and 1.5 Gy and for 1.5%, it was between 1.5 and 2 Gy.ConclusionsIn procedures performed on the arteries of the lower limbs, a significantly higher dose was received by patients with TASC II C lesions. With regard to the number of stents implanted, the total DAP value was 50% higher for simultaneous three-stent implantation than for one or two stents

Rare variations of hepatic arteries in association with variable origin of gastroduodenal artery found in multidetector computed tomography angiography

Three rare anatomical variations were found during study on hepatic arterial vascularisation in multidetector computed tomography angiography. In the first described variation the common hepatic artery (CHA) arises from the celiac trunk (CTr) and supplies right hepatic lobe. The left lobe of the liver is supplied by aberrant left hepatic artery originating as a common trunk with the left gastric artery and the splenic artery. This variation may correspond to the type 2 in Michels’ classification coexisting with one of three possible patterns of the CTr division (when the CHA is the first branch of the CTr and the gastrosplenic trunk is the second one). The second variation corresponds to the very early bifurcation of the CHA arising from the CTr. Both, the right and left hepatic arteries originate separately from the CTr. The gastroduodenal artery (GDA) originates from the left hepatic artery. It may be regarded as the variation of most common type 1 according to Michels. In the third case the CHA gives raise to the GDA and terminates as the right hepatic artery supplying the right lobe of the liver only. The proper hepatic artery is missing and the left hepatic artery arises from the GDA. This variation does not correspond to any types of Michels’ classification.

Flow Changes after Endovascular Treatment of a Wide-Neck Anterior Communicating Artery Aneurysm by using X-configured Kissing Stents (Cross-Kissing Stents) Technique

Endovascular treatment for a wide-neck anterior communicating artery (AcomA) aneurysm remains technically challenging. Stent-assisted embolization has been proposed as an alternative of treatment of complex aneurysms. The X-configuration double-stent-assisted technique was used to achieve successful coiling of wide-neck AcomA aneurysm. Implanted stent can alter intra-arterial flow. Follow-up angiograms 4 months later showed flow changes due to used X-technique of stents implantation and filling of the anterior cerebral artery from the opposite internal carotid artery

Management of acute ischaemic stroke due to Sheldon catheter insertion into the right common carotid artery using the aspiration thrombectomy: a case report

Accidental carotid cannulation using a large-bore catheter is one of the complications of central venous catheter insertion, reported in 1 % of performed procedures. Management of arterial catheterization contains direct manual compression, endovascular treatment, and open surgical repair. Inadvertent arterial cannulation can lead to hemorrhage, pseudoaneurysm, arteriovenous fistula, stroke or death. Mechanical removal of thrombotic material is presently the most effective method of stroke treatment. Rapid and early restoration of blood flow is crucial for the improvement of the neurological condition. This report describes a case of a patient with signs of severe stroke after management of accidental carotid catheterization using balloon tamponade. Aspiration thrombectomy was successfully performed to manage acute ischaemia of the brain