History of Neurointervention

Sahoo, Anurag; Abdalkader, Mohamad; Saatci, Isil; Raymond, Jean; Qiu, Zhongming; Huo, Xiaochuan; Sun, Dapeng; Weyland, Charlotte S.; Jia, Baixue; Zaidat, Osama O.; Hu, Wei; Qureshi, Adnan I.; Miao, Zhongrong; Nguyen, Thanh N.

doi:10.1055/s-0043-1771455

Cited by 3 publications

(2 citation statements)

References 154 publications

(188 reference statements)

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“…Although developed roughly 100 years ago, the success of Seldinger's work in the 1950s spawned a steady increase in the type, frequency and availability of angiography globally. 11 The advantages of pupillometry are well documented in providing new metrics with higher accuracy, precision and reliability than subjective PLR assessment. [12][13][14][15] What remains unknown is whether changes in PLR metrics can be attributed to periprocedural events or whether these changes reflect new or worsening neurological deficits.…”

Section: Open Accessmentioning

confidence: 99%

Prospective study examining the impact of cerebral angiography on quantitative pupillometer values in the interventional radiology suite

Nguyen,

Marshall,

Rana

et al. 2024

BMJ Open

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ObjectivesThe purpose of this pilot study was to obtain baseline quantitative pupillometry (QP) measurements before and after catheter-directed cerebral angiography (DCA) to explore the hypothesis that cerebral angiography is an independent predictor of change in pupillary light reflex (PLR) metrics.DesignThis was a prospective, observational pilot study of PLR assessments obtained using QP 30 min before and after DCA. All patients had QP measurements performed with the NPi-300 (Neuroptics) pupillometer.SettingRecruitment was done at a single-centre, tertiary-care academic hospital and comprehensive stroke centre in Dallas, Texas.ParticipantsFifty participants were recruited undergoing elective or emergent angiography. Inclusion criteria were a physician-ordered interventional neuroradiological procedure, at least 18 years of age, no contraindications to PLR assessment with QP, and nursing transport to and from DCA. Patients with a history of eye surgery were excluded.Main outcome measuresDifference in PLR metric obtained from QP 30 min before and after DCA.ResultsStatistically significant difference was noted in the pre and post left eye readings for the minimum pupil size (a.k.a., pupil diameter on maximum constriction). The mean maximum constriction diameter prior to angiogram of 3.2 (1.1) mm was statistically larger than after angiogram (2.9 (1.0) mm; p<0.05); however, this was not considered clinically significant. Comparisons for all other PLR metrics pre and post angiogram demonstrated no significant difference. Using change in NPi pre and post angiogram (Δpre=0.05 (0.77) vs Δpost=0.08 (0.67); p=0.62), we calculated the effect size as 0.042. Hence, detecting a statistically significant difference in NPi, if a difference exists, would require a sample size of ~6000 patients.ConclusionsOur study provides supportive data that in an uncomplicated angiogram, even with intervention, there is no effect on the PLR.

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Section: Open Accessmentioning

confidence: 99%

Prospective study examining the impact of cerebral angiography on quantitative pupillometer values in the interventional radiology suite

Nguyen,

Marshall,

Rana

et al. 2024

BMJ Open

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“…Cerebral angiography, an X-ray examination method, involves the injection of iodinated contrast mediums (ICM) into the carotid or vertebral arteries, contributing to the visualization of cerebral blood vessels and the diagnosis of conditions such as intracranial aneurysms, vascular malformations, and craniocerebral space-occupying lesions. 1 Currently, the common approach for cerebral angiography involves catheterization through the transradial approach and transfemoral approach. 2 Meanwhile, ICM used in cerebral angiography are categorized as ionic, nonionic monomeric, and nonionic dimeric compounds.…”

Section: Introductionmentioning

confidence: 99%

Case Report: A Rare Case of Iodixanol-Induced Anaphylactic Shock in Cerebral Angiography

Zhao,

Wang,

et al. 2024

JAA

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Background Adverse reactions induced by isoosmolar contrast medium (iodixanol) are mostly mild, with rashes and headaches being the most common. Although anaphylactic shock has been reported, no related incidents have been documented on cerebral angiography. Objective This article reports a serious case of anaphylactic shock possibly induced by iodixanol and provides an overview of the case report. Case Summary A 65-year-old female with persistent headaches for nearly six months and CTA examination revealed multiple intracranial aneurysms. After two treatments, she returned to the hospital for aneurysm of reexamination a month ago. Following a preoperative assessment, cerebral angiography was performed. Three minutes after the procedure, the patient experienced dizziness, increased heart rate, followed by hypotension (BP 90/43 mm Hg), a sudden drop-in heart rate (HR 68 bpm), and a drop in SpO2 to 92%. Intravenous dexamethasone for anti-allergic were administered immediately, along with therapy through oxygen-inhalation. However, the patient then developed limb convulsions, unresponsiveness, and was urgently given diazepam for sedation and sputum aspiration to maintain airway patency. Blood pressure decrease to 53/29 mm Hg, and SpO2 readings were unavailable. Intravenous dopamine to elevates blood pressure, and assists breathing by intubating in the endotracheal. After 3 minutes, as the blood pressure remained undetectable, intermittent intravenous epinephrine 1mg was administered to raise the blood pressure, gradually restoring it to 126/90 mm Hg, and SpO2 increased to 95%. The patient was diagnosed with iodixanol-induced anaphylactic shock and urgently transferred to the NICU for monitoring and treatment. The patient died despite immediate treatment. Conclusion A 65-year-old female developed serious anaphylactic shock during cerebral angiography after receiving iodixanol. Although iodixanol is considered one of the safest iodinated contrast mediums (ICM), clinicians should be aware of its the potential for serious hypersensitivity reactions that can lead to fatal and life-threatening events.

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Experimental study using phantom models of cerebral aneurysms and 4D-DSA to measure blood flow on 3D-color-coded images

Fujimura,

Yamanaka,

Kan

et al. 2024

THC

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BACKGROUND: The current 3D-iFlow application can only measure the arrival time of contrast media through intensity values. If the flow rate could be estimated by 3D-iFlow, patient-specific hemodynamics could be determined within the scope of normal diagnostic management, eliminating the need for additional resources for blood flow rate estimation. OBJECTIVE: The aim of this study is to develop and validate a method for measuring the flow rate by data obtained from 3D-iFlow images – a prototype application in Four-dimensional digital subtraction angiography (4D-DSA). METHODS: Using phantom model and experimental circuit with circulating glycerin solution, an equation for the relationship between contrast media intensity and flow rate was developed. Applying the equation to the aneurysm phantom models, the derived flow rate was evaluated. RESULTS: The average errors between the derived flow rate and setting flow rate became larger when the glycerin flow and the X-rays from the X-ray tube of the angiography system were parallel to each other or when the measurement point included overlaps with other contrast enhanced areas. CONCLUSION: Although the error increases dependent on the imaging direction and overlap of contrast enhanced area, the developed equation can estimate the flow rate using the image intensity value measured on 3D-iFlow based on 4D-DSA.

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History of Neurointervention

Cited by 3 publications

References 154 publications

Prospective study examining the impact of cerebral angiography on quantitative pupillometer values in the interventional radiology suite

Prospective study examining the impact of cerebral angiography on quantitative pupillometer values in the interventional radiology suite

Case Report: A Rare Case of Iodixanol-Induced Anaphylactic Shock in Cerebral Angiography

Experimental study using phantom models of cerebral aneurysms and 4D-DSA to measure blood flow on 3D-color-coded images

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