Catheterization angiography

Fang J, Eisenhauer A, Profiles in cardiomyopathy and congestive heart failure, Textbook Grossman s Cardiac Catheterization, Angiography, and Intervention. Seventh Edition, Lippincott Williams Wilkins, 2005. 

Fig. 8.12 Optimal biphasic tilt waveform. See text for details. (From Cohen SI, Schuger C. Implantable devices for the treatment of rhythm disturbances. In Barm DS, Grossman W, eds. Cardiac catheterization, angiography, and intervention, 5th ed. Baltimore Williams Wilkins, 1996 508, with permission.)...

Very low-risk patients are not good candidates for CT imaging due to the risk of contrast and radiation exposure. Cardiac CT imaging based on the current standard of retrospective helical acquisitions is associated with a radiation dose exposure of 15mSv (three times the average exposure rate of conventional catheterization angiography), precluding use of the method for asymptomatic patients. 

The predominance of coronary anomalies is composed of abnormal branching patterns of the proximal segments. CT is therefore used in many instances of suspected coronary anomalies after catheterization angiography to verify or supplement suspected findings. The supplemental function includes visualizing abnormal branches that could either not be reached by the catheter tip during the catheterization procedure or were not at all detected. For this application, CT offers the only way to assess the peripheral parts of that particular branch. Hence, all the restrictions apply as mentioned in the section on initial CAD workup. 

Tremendous advances in scanner technology introduced in the recent years made cardiac CT a clinical reality. Automated software has reduced image postprocessing time to a few minutes. Coronary tree extraction allows obtaining projections of the CT dataset that resemble the views familiar from catheterization angiography. But application of the method today is confined to a selected range of patients. This is due to the many restrictions that prevail. 

Cardiac catheterization and coronary angiography are used in patients with suspected CAD to document the presence and severity of disease as well as for prognostic purposes. Interventional catheterization is used for thrombolytic therapy in patients with acute MI and for managing patients with significant CAD to relieve obstruction through percutaneous transluminal coronary angioplasty, atherectomy, laser treatment, or stent placement. 

The current situation is exemplified by a study of clinical staff exposures in cardiac angiography at the Montreal Heart Institute (Renaud, 1992). Extensive measurements of staff exposures were made using thermoluminescent dosimeters (TLDs) for 15,000 procedures in three cardiac catheterization laboratories over a 5 y period (1984 to 1988). The TLDs were located under the protective apron at the waist and at the collar outside and above the apron. Readings were made at three-month intervals, with a minimum reportable value of 0.2 mSv. Average values (in mSv per y) for various groups of staff, based on measurements with TLDs worn at the collar, are given in Table 3.3. 

Other uses of fluoroscopy would have the potential for higher cumulative collar exposures. For example, abdominal interventional and angiography procedures typically use image intensifiers and x-ray field sizes which are larger than those used in a cardiac catheterization laboratory. Depending on the orientation of the primary beam, the scattered radiation from the patient may have greater intensity in these other clinical situations than in a cardiac catheterization laboratory. 

Chou, T.M. et al. (2002) Photodynamic therapy applications in atherosclerotic vascular disease with motexafin lutetium, Catheterization and cardiovascular interventions official journal of the Society for Cardiac Angiography Interventions 57, 387-394. 

Taylor AJ, Hotchkiss D, Morse RW, et al. PREPARED Preparation for Angiography in Renal Dysfunction a randomized trial of inpatient vs outpatient hydration protocols for cardiac catheterization in mild-to-moderate renal dysfunction. Chest 1998 I 14 1570-1574. 

Vitek JJ. Femoro-cerebral angiography analysis of 2,000 consecutive examinations, special emphasis on carotid arteries catheterization in older patients. Am J Roentgenol Radium Ther Nucl Med 1973 I 18 633-647. 

The best explanation of this observation is that a large amount of contrast medium entered the vertebral artery and passed upwards, passing a defective blood-brain barrier. Similar complications have been described in other patients, sometimes with amnesia, after cardiac catheterization and angiography (SEDA-18, 444). 

Johnson LW, Krone R. Cardiac catheterization 1991 a report of the Registry of the Society for Cardiac Angiography and Interventions (SCA I). Cathet Cardiovasc Diagn 1993 28(3) 219-20. 

Katzberg RW, MorrisTW, Burgener FA, Kamm DE, Fischer HW. Renal renin and hemodynamic responses to selective renal artery catheterization and angiography. Invest Radiol 1977 12 381 -388. 

L. W. Klein, M. J. Kern, P. Berger, T. Sanborn, P. Block, J Babb, C. Tommaso, J. M. Hodgson, T. Feldman, Society of cardiac angiography and interventions suggested management of the no-reflow phenomenon in the cardiac catheterization laboratory, Catheter Cardiovasc Interv 60, 194—201 (2003). 

Cardiac catheterization and angiography are used to assess coronary anatomy and ventricular performance. 

Following interventional procedures such as PTCA, catheterization with angiography can be used to evaluate efficacy of the intervention. In recurrent clinical syndromes, following a procedure, catheterization is used to help delineate a new management strategy. Catheterization is also now used commonly with PTCA and/or drug therapy in the management of acute coronary syndromes. 

The cardiac catheterization procednre reqnires vascnlar access, nsually obtained percutaneonsly at brachial or femoral arteries or veins. Left-sided catheterization provides access to the aorta, left ventricle, and left atrinm. Right-sided catheterization enables the right side of the heart, coronary sinus, pulmonary arteries, and pulmonary wedge position to be reached. Left-sided catheterization is used for coronary angiography and ventriculography, whereas rightsided catheterization is nsed for determination of cardiac performance parameters. 

ECHO is the use of ultrasound to visualize anatomic structures such as the valves within the heart and to describe wall motion. Clinically, ECHO is the most frequently used noninvasive cardiovascular test, aside from the ECG. It competes well with invasive techniques such as cardiac catheterization with angiography for the evaluation of ischemia and valvular abnormalities. ECHO is... 

Bairn DS, Grossman W. Diagnostic cardiac catheterization and angiography. In Fauci AS, Braun wald E,lsselbacherKJ, etal, eds. Harrison s Principles of Internal Medicine, 14th ed.New York, McGraw-Hill, 1998 1247-1253. 

---