Rupture and Migration of an Endovascular Stent in the Brachiocephalic Trunk Causing a Vertebral Steal Syndrome

Delayed stent fracture has been observed in many different arteries and may represent a risk factor for restenosis. We describe the case of a delayed rupture of an endovascular brachiocephalic trunk stent. The complete fracture allowed a fragment to migrate distally and tilt, resulting in a hemodynamic pattern similar to that of a prevertebral stenosis with complete inversion of the homolateral vertebral blood flow. The induced vertebral steal syndrome as well as the risk of cerebral embolism was corrected by an aortobrachiocephalic bypass and resection of the ruptured sten

Assessment of occlusive arterial disease of abdominal aorta and lower extremities arteries: value of multidetector CT angiography using an adaptive acquisition method

We evaluated 16-detector-row CT in the assessment of occlusive peripheral arterial disease (PAD) of the abdominal aorta and lower extremities using an adaptive method of acquisition to optimise arterial enhancement especially for the distal foot arteries. Thirty-four patients underwent transcatheter angiography (TCA) and CT angiography within 15days. For each patient, table speed and rotation were selected according to the calculated optimal transit time of contrast material obtained after a single bolus test and two dynamic acquisitions at aorta and popliteal arteries. Analysis included image quality and detection of stenosis equal or greater than 50% on a patient basis and on an arterial segment basis. Sensitivity and specificity of CT were calculated with the TCA considered as the standard of reference. CT was conclusive in all segments with no technical failures even in difficult cases with occluded bypasses and aneurysms. On patient-basis analysis, the overall sensitivity and specificity to detect significant stenosis greater than 50% were both 100%. Segmental analysis shows high values of sensitivity and specificity ranging from 91 to 100% and from 81 to 100%, respectively, including distal pedal arteries. Sixteen-detector-row CT angiography using an adaptive acquisition improves the image quality and provides a reliable non-invasive technique to assess occlusive peripheral arterial disease, including distal foot arterie

A New Clinically Driven Classification for Acute Aortic Dissection.

Objectives: To report a new classification scheme for acute aortic dissection (AAD) that considers the aortic arch as a separate entity and integrates patterns of malperfusion syndrome (MPS). The proposed classification was evaluated retrospectively in a large population. Materials and Methods: We retrospectively reviewed pre-therapy CT angiograms of 226 consecutive patients (mean ± SD age: 64 ± 12 years) with AAD. AADs were reclassified with a new classification scheme that included three aortic dissection types (A, involving at least the ascending aorta; B, involving exclusively the descending aorta; and C, involving the aortic arch with/without the descending aorta) and four malperfusion grades (0: no MPS; 1: dynamic MPS; 2: static MPS; 3: static and dynamic MPS). AAD features were assessed and correlated to patient outcomes. Results: According to the new classification, we identified 152 type A dissections (92 A0, 11 A1, 38 A2, 11 A3); 50 type B (38 B0, 5 B1, 6 B2, 1 B3); and 24 type C (17 C0, 6 C2, 1 C3). Type C represented 11% of all AADs. MPS occurred in 39, 24, and 29% in type A, B, and C, respectively. Type C was treated with significantly more endovascular or hybrid interventions (37%) than in types A (3%) and B (20%) (p < 0.001). Conclusion: The new AAD classification was feasible, and type C was easily identified ("non-A, non-B"). Preliminary findings supported the usefulness of this classification for the decision-making process and subsequent treatments

Association between computed tomography obstruction index and mortality in elderly patients with acute pulmonary embolism: A prospective validation study.

Computed tomography pulmonary angiography (CTPA) has not only become the method of choice for diagnosing acute pulmonary embolism (PE), it also allows for risk stratification of patients with PE. To date, no study has specifically examined the predictive value of CTPA findings to assess short-term prognosis in elderly patients with acute PE who are particularly vulnerable to adverse outcomes. We studied 291 patients aged ≥65 years with acute symptomatic PE in a prospective multicenter cohort. Outcomes were 90-day overall and PE-related mortality, recurrent venous thromboembolism (VTE), and length of hospital stay (LOS). We examined associations of the computed tomography obstruction index (CTOI) and the right ventricular (RV) to left ventricular (LV) diameter ratio with mortality and VTE recurrence using survival analysis, adjusting for provoked VTE, Pulmonary Embolism Severity Index (PESI), and anticoagulation as a time-varying covariate. Overall, 15 patients died within 90 days. There was no association between the CTOI and 90-day overall mortality (adjusted hazard ratio per 10% CTOI increase 0.92; 95% confidence interval [CI] 0.70-1.21; P = 0.54), but between the CTOI and PE-related 90-day mortality (adjusted sub-hazard ratio per 10% CTOI increase 1.36; 95% CI 1.03-1.81; P = 0.03). The RV/LV diameter ratio was neither associated with overall nor PE-related 90-day mortality. The CTOI and the RV/LV diameter ratio were significantly associated with VTE recurrence and LOS. In elderly patients with acute PE, the CTOI was associated with PE-related 90-day mortality but not with overall 90-day mortality. The RV/LV diameter ratio did not predict mortality. Both measures predicted VTE recurrence and LOS. The evaluated CTPA findings do not appear to offer any advantage over the PESI in terms of mortality prediction

Ability of FFR-CT to detect the absence of hemodynamically significant lesions in patients with high-risk NSTE-ACS admitted in the emergency department with chest pain, study design and rationale.

In the era of High-sensitive troponin (hs-Tn), up to 50% of patients with a mild increase of hs-Tn will finally have a normal invasive coronary angiogram. Fractional Flow Reserve (FFR) derived from coronary computed tomographic angiography (FFR-CT) has never been used as a non-invasive tool for the diagnosis of coronary artery disease in patients with high-risk acute coronary syndrome without ST segment elevation (NSTE-ACS). The study aims to determine the role of coronary CT angiography and FFR-CT in the setting of high-risk NSTE-ACS. We will conduct a prospective trial, enrolling 250 patients admitted with high-risk NSTE-ACS who will rapidly undergo a coronary CT angiography and then a coronary angiography with FFR measurements. Results of coronary CT, FFR-CT and coronary angiography (± FFR) will be compared. In conclusion, non-invasive identification of patients with high-risk NSTE-ACS who could avoid coronary angiography would reduce procedure related risks and medical costs

Investigating the Influence of High-Speed Gantry Rotation in Cardiac CT on Motion Artifacts in Aortic Stenosis Patients Not Premedicated with β-Blockers: The FAST-CCT Randomized Trial Protocol.

Coronary CT angiography (CCTA) is increasingly used as a non-invasive tool to assess coronary artery disease (CAD). However, CCTA is subject to motion artifacts, potentially limiting its clinical utility. Despite faster (0.35 and 0.28 s/rot) gantry rotation times, low (60-65 bpm) heartbeat is recommended, and the use of β-blockers is often needed. Technological advancements have resulted in the development of faster rotation speeds (0.23 s/rot). However, their added value in patients not premedicated with β-blockers remains unclear. This prospective single-center, two-arm, randomized, controlled trial aims to assess the influence of fast rotation on coronary motion artifacts, diagnostic accuracy of CCTA for CAD, and patient safety. We will randomize a total of 142 patients aged ≥ 50 scheduled for an aortic stenosis work-up to receive CCTA with either a fast (0.23) or standard (0.28 s/rot) gantry speed. rate of CCTAs with coronary motion artifacts hindering interpretation. assessable coronary segments rate, diagnostic accuracy against invasive coronary angiography (ICA), motion artifact magnitude per segment, contrast-to-noise ratio (CNR), and patient ionizing radiation dose. The local ethics committee has approved the protocol. Potential significance: FAST-CCT may improve motion artifact reduction and diagnosis quality, thus eliminating the need for rate control and β-blocker administration. gov identifier: NCT05709652

Long-term follow-up of surgically excluded popliteal artery aneurysms with multi-slice CT angiography and Doppler ultrasound

The purpose of this study was to evaluate the role of multi-slice computed tomography (MSCT) angiography in the follow-up of popliteal artery aneurysms (PAAs) that have been operated on. Aneurysm exclusion and progression, graft patency and graft-related complications were analyzed. Fourteen patients with 21 surgically excluded PAAs were evaluated with MSCT angiography with slice thickness of 1.25 mm. The mean follow-up time was 67 months. MSCT demonstrated blood flow in six non-excluded PAAs (24%), with an average increase in the diameter of 21 mm over time. Fifteen PAAs demonstrated no blood flow and revealed an average decrease of 7 mm in diameter. The origin of this residual perfusion was demonstrated, and collaterals were involved in five of six non-excluded PAAs. In addition, MSCT demonstrated three graft stenoses. Furthermore, two occluded grafts were visualized. Twenty-four percent of the patients after surgical exclusion of PAAs revealed residual perfusion within the aneurysmal sac during follow-up, with a significant increase in the aneurysmal size with MSCT. Moreover, evaluation of the graft patency could also be done as could demonstration of anastomotic abnormalities. Thus, MSCT might be considered as a new tool to evaluate residual collateral feeding of popliteal aneurysmal sac and could be useful in identification and localization of feeding vessels

Erratum to: Comparative assessment of image quality for coronary CT angiography with iobitridol and two contrast agents with higher iodine concentrations: iopromide and iomeprol. A multicentre randomized double-blind trial

Unfortunately, there is amistake in the section Results, Clinical safety. While the text states that “no severe AEs were reported”, in fact one severe AE was reported in the iomeprol group (one severe injection site pain assessed as possibly related to contrast agent), as shown in Table 5. In addition, the name of the author Jean-François Paul was rendered incorrectly in the original publication but has since been corrected. The authors apologize for these mistakes

Cardiothoracic CT: one-stop-shop procedure? Impact on the management of acute pulmonary embolism

In the treatment of pulmonary embolism (PE) two groups of patients are traditionally identified, namely the hemodynamically stable and instable groups. However, in the large group of normotensive patients with PE, there seems to be a subgroup of patients with an increased risk of an adverse outcome, which might benefit from more aggressive therapy than the current standard therapy with anticoagulants. Risk stratification is a commonly used method to define subgroups of patients with either a high or low risk of an adverse outcome. In this review the clinical parameters and biomarkers of myocardial injury and right ventricular dysfunction (RVD) that have been suggested to play an important role in the risk stratification of PE are described first. Secondly, the use of more direct imaging techniques like echocardiography and CT in the assessment of RVD are discussed, followed by a brief outline of new imaging techniques. Finally, two risk stratification models are proposed, combining the markers of RVD with cardiac biomarkers of ischemia to define whether patients should be admitted to the intensive care unit (ICU) and/or be given thrombolysis, admitted to the medical ward, or be safely treated at home with anticoagulant therapy