Impact of dye injection on intracoronary pressure

Stoel, Martin G.; Kandhai-Ragunath, Jasveen J.; Houwelingen, Gert van; Birgelen, Clemens von

doi:10.4244/eijv5i2a42

Cited by 4 publications

(6 citation statements)

References 17 publications

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“…Contrast injection causes a temporal and small increase in intracoronary pressure during coronary angiography. Using a pressure guidewire, a previous study showed that the absolute and relative increase of mean intracoronary pressure due to manual contrast injection for angiography was 6.0 AE 4.2 mmHg and 6.7 AE4.9%, respectively [3]. Similarly, in the present study, the increase in intracoronary pressure due to automated contrast injection for angiography was small.…”

Section: Coronary Angiography and Intracoronary Pressure Increasesupporting

confidence: 64%

“…Since nearinfrared light is attenuated by red blood cells, OCT requires intracoronary injection of contrast media to remove blood from the field of view during the image acquisition. A previous coronary angiography study demonstrated that contrast injection caused a temporal increase in intracoronary pressure [3]. The excessive increase in intracoronary pressure may enlarge coronary artery dissections induced by catheters, guide wires, and/or angioplasty devices (e.g.…”

Section: Introductionmentioning

confidence: 99%

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Intracoronary pressure increase due to contrast injection for optical coherence tomography imaging

Shimamura

Kubo

Ino

et al. 2020

Journal of Cardiology

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Background: Optical coherence tomography (OCT) requires intracoronary injection of contrast media to remove blood from the field of view during image acquisition. Contrast injection may cause a temporal increase in intracoronary pressure. The aim of this study was to compare the intracoronary pressure during contrast injection between OCT and coronary angiography. Methods: We measured intracoronary pressure by using a pressure guidewire during contrast injection for OCT and angiography in 30 coronary arteries (mean fractional flow reserve = 0.90 AE 0.03). Contrast media was injected into coronary artery through the guiding catheter by using a mechanical injector pump. Results: Intracoronary pressure before contrast injection was similar between OCT and angiography (systolic pressure: 123 AE 18 mmHg vs. 122 AE 19 mmHg, p = 0.863). Intracoronary pressure was increased due to contrast injection in both OCT (systolic pressure: 123 AE 18 mmHg to 132 AE 18 mmHg, p < 0.001) and angiography (systolic pressure: 122 AE 19 mmHg to 128 AE 19 mmHg, p < 0.001). The increase in intracoronary pressure was slightly greater in OCT compared with angiography (absolute increase of systolic pressure: 9 AE 2 mmHg vs. 6 AE 1 mmHg, p < 0.001; and relative increase of systolic pressure: 8 AE 2% vs. 5 AE 1%, p < 0.001). Intracoronary pressure during contrast injection was not significantly different between OCT and angiography (systolic pressure: 132 AE 18 mmHg vs. 128 AE 19 mmHg, p = 0.831). Conclusions: Contrast injection for OCT induced significant but small increase in intracoronary pressure compared with that for angiography.

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Section: Coronary Angiography and Intracoronary Pressure Increasesupporting

confidence: 64%

Section: Introductionmentioning

confidence: 99%

Intracoronary pressure increase due to contrast injection for optical coherence tomography imaging

Shimamura

Kubo

Ino

et al. 2020

Journal of Cardiology

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“…21 There was no statistical difference between intracoronary pressure increases measured at discrete distances from the catheter tip during coronary angiography in 6 patients. 22 While possibly not related to pressure increase, one basilar tip aneurysm rupture visualized during angiography occurred when the catheter-tip was at the junction of the subclavian and vertebral arteries, an estimated 37 cm away. 10 Retrograde brachial artery injections can cause pressure increases in the carotid 21 and a case report 8 showed contrast extravasation from potential re-rupture of an anterior communicating artery aneurysm during a brachial injection.…”

Section: Discussionmentioning

confidence: 97%

“…However, it is clear that contrast injections cause a transient increase in intravascular pressure distal to the catheter-tip. [16][17][18][19][20][21][22][23][24] It is then reasonable to infer that increased intraneurysmal pressures during injections will cause ARAR in the setting of a ruptured and fragile aneurysmal wall 'sealed' with thrombus. 7,8,10,25,26 The fluid dynamics phenomena that occur at the catheter-tip during contrast injections are extremely complex involving the dispersion and mixing of a potentially turbulent contrast jet with co-flowing laminar pulsatile blood flow and associated vortical flow structures.…”

Section: Introductionmentioning

confidence: 99%

“…[17][18][19][20][21][22][23][24] Intracoronary pressures measured during contrast injections for coronary angiography in 25 patients with non-significant lesions showed pressure increases of about 7 AE 6% relative to the baseline. 22 Pressures measured 2-3 cm distal to the catheter-tip during rotational angiography injections (18 cc at 3 cc/s through a 5 Fr catheter) in 25 unruptured aneurysm patients showed average pressure increases of 20% in mean pressure and 12% in systolic pressure. 23 We are aware of only one study 18 that has measured intraneurysmal pressures in patients during contrast injections.…”

Section: Introductionmentioning

confidence: 99%

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An in vitro study of pressure increases during contrast injections in diagnostic cerebral angiography

et al. 2021

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Background During diagnostic cerebral angiography, the contrast bolus injected into a vessel can cause substantial changes in baseline pressures and flows. One potential, and serious complication is the re-rupture of aneurysms due to these injections. The goals of this in vitro study were to evaluate the effect of injection conditions on intraneurysmal pressure changes during angiography. Methods A silicone replica of a complete circle of Willis model with ophthalmic, anterior communicating, and basilar tip aneurysms was connected to a physiologically accurate flow pump. Contrast injections were performed under different conditions (carotid or vertebral vessel imaging, catheter diameter, injection rate, injection time, and arterial blood flow rate) and the pressure in each aneurysm was recorded before and during each injection. The effect of injection conditions on percentage increase in aneurysm pressures was statistically assessed. Additionally, the effect of the distance between the aneurysm and the catheter-tip on aneurysmal pressures was assessed. Results Mean intraneurysmal pressures during injection (84.5 ± 10.8 mmHg) were significantly higher than pre-injection pressures (80.4 ± 10.6 mmHg, p < 0.0001). Only 3 of the 5 conditions – carotid injections, higher injection rates, and smaller catheter diameters – significantly increased intraneurysmal pressures. The catheter-tip distance showed no correlation to pressure increases. Conclusions Increasing contrast injection rates and decreasing catheter diameters are correlated to intraneurysmal pressure increases during angiography irrespective of the distance to the catheter tip. Future in vivo studies are required to confirm these findings and determine whether the amplitude of pressure increases with commonly used injection rates can be clinically detrimental.

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Pressure and Flow Rate Changes During Contrast Injections in Cerebral Angiography: Correlation to Reflux Length

Kovarovic

Woo

Fiorella

et al. 2018

Cardiovasc Eng Tech

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Cerebral angiography involves the antegrade injection of contrast media through a catheter into the vasculature to visualize the region of interest under X-ray imaging. Depending on the injection and blood flow parameters, the bolus of contrast can propagate in the upstream direction and proximal to the catheter tip, at which point contrast is said to have refluxed. In this in vitro study, we investigate the relationship of fundamental hemodynamic variables to this phenomenon. Contrast injections were carried out under steady and pulsatile flow using various vessel diameters, catheter sizes, working fluid flow rates, and injection rates. The distance from the catheter tip to the proximal edge of the contrast bolus, called reflux length, was measured on the angiograms; the relation of this reflux length to different hemodynamic parameters was evaluated. Results show that contrast reflux occurs when the pressure distal to the catheter tip increases to be greater than the pressure proximal to the catheter tip. The ratio of this pressure difference to the baseline flow rate, called reflux resistance here, was linearly correlated to the normalized reflux length (reflux length/vessel diameter). Further, the ratio of blood flow to contrast fluid momentums, called the Craya-Curtet number, was correlated to the normalized reflux length via a sigmoid function. A sigmoid function was also found to be representative of the relationship between the ratio of the Reynolds numbers of blood flow to contrast and the normalized reflux length. As described by previous reports, catheter based contrast injections cause substantial increases in local flow and pressure. Contrast reflux should generally be avoided during standard antegrade angiography. Our study shows two specific correlations between contrast reflux length and baseline and intra-injection parameters that have not been published previously. Further studies need to be conducted to fully characterize the phenomena and to extract reliable indicators of clinical utility. Parameters relevant to cerebral angiography are studied here, but the essential principles are applicable to all angiographic procedures involving antegrade catheter injections.

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Impact of dye injection on intracoronary pressure

Abstract: The authors have no conflict of interest to declare.

Cited by 4 publications

References 17 publications

Intracoronary pressure increase due to contrast injection for optical coherence tomography imaging

Intracoronary pressure increase due to contrast injection for optical coherence tomography imaging

An in vitro study of pressure increases during contrast injections in diagnostic cerebral angiography

Pressure and Flow Rate Changes During Contrast Injections in Cerebral Angiography: Correlation to Reflux Length

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