ABSTRACT
BACKGROUND: We have used a contrast injection scheme termed as "guided catheterization method (guided method)." By using a large-bore 5-Fr catheter and 0.032-in guidewire, a contrast medium could be injected without removing the guidewire. Using a neurovascular phantom, we studied the influence of leaving the guidewire on the contrast injection pressure. Image quality was compared with that obtained using a 4-Fr regular angiography catheter (conventional method). METHODS: Actual contrast injection pressure, flow rate, flow volume, and several variables from the time-density curve (TDC) were obtained using the guided method and the conventional method. Catheterization parameters included flow rate, the viscosity of a contrast medium (CM), and catheter length. The pressure limit of a contrast injector was set as 1200 psi. Digital subtraction angiography (DSA) images on the neurovascular phantom were acquired. The DSA images were processed, and TDC on a specific region of interest was obtained. Variables from TDC were calculated and compared between the different catheters. RESULTS: The ranges of actual contrast injection pressure with the conventional and the guided method were 138-299 psi and 184-451 psi, respectively. A minimal reduction of the actual flow rate was found under some conditions with the guided method. Comparable opacifications in DSA images were achieved in all conditions. Although peak intensity was different by flow rate or CM, all TDC variables did not differ based on the catheter. There were no significant harmful events during the 90 experiments. CONCLUSIONS: With adjustment of the pressure limit, cerebral angiography using the 5-Fr, large-bore catheter without removal of the guidewire is feasible, safe, and expected to provide image quality comparable to that of the 4-Fr regular catheter.
Subject(s)
Catheterization , Contrast Media , Angiography, Digital Subtraction , Catheters , Cerebral Angiography , HumansABSTRACT
Objective To discuss the application of different types of bronchial arteriography catheter in performing bronchial artery embolization (BAE) for the treatment of hemoptysis.Methods The clinical data of a total of 97 patients with hemoptysis,who received BAE during the period from January 2013 to May 2016,were collected.According to angiographic findings in aspect of the opening and running direction of the arteries causing bleeding,the responsible arteries were divided into 4 types:upward opening,horizontal opening and running upwards,horizontal opening and running downwards,and downward opening.For each responsible artery,appropriate angiography catheter was selected from the following catheters:MIK catheter,left gastric artery catheter,Cobra catheter,Simmon-1 catheter and Simmon-2 catheter.With super-selective catheterization technique the selected suitable catheter was inserted into the responsible artery and angiography was subsequently performed.The effect of the selection of bronchial arteriography catheter in performing BAE for hemoptysis was analyzed.Results A total of 180 responsible arteries were detected in 97 patients.Of the 180 responsible arteries,artery with upward opening was seen in 42,artery with horizontal opening and running upwards was found in 54,artery with horizontal opening and running downwards was observed in 46,and artery with downward opening was detected in 38.The success rates of super-selective catheterization for MIK catheter,left gastric artery catheter,Cobra catheter and Simmon catheter were 83.3％ (35/42),92.6％ (50/54),87.0％ (40/46) and 89.5％ (34/38,including 30 Simmon-1 catheters and 4 Simmon-2 catheters) respectively.After BAE,the responsible arteries were occluded in all patients,and hemoptysis stopped immediately.The recurrence rate at 6 months after BAE was 7.2％ (7/97).Conclusion For the treatment of hemoptysis,BAE is safe and effective.The key point to ensure a successful BAE is that the selection of appropriate catheter should be based on the opening and running direction of the artery causing bleeding.
