2D-Perfusion Angiography Using Carbon Dioxide (CO2): A Feasible Tool to Monitor Immediate Treatment Response to Endovasc
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TECHNICAL NOTE
IMAGING
2D-Perfusion Angiography Using Carbon Dioxide (CO2): A Feasible Tool to Monitor Immediate Treatment Response to Endovascular Therapy of Peripheral Arterial Disease? Cornelia L. A. Dewald1 • Lena S. Becker1 • Sabine K. Maschke1 • Timo C. Meine1 Bernhard C. Meyer1 • Frank K. Wacker1 • Jan B. Hinrichs1
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Received: 16 July 2020 / Accepted: 19 November 2020 The Author(s) 2020
Abstract Purpose Patients with peripheral arterial disease (PAD) or critical limb ischemia (CLI) require revascularization. Traditionally, endovascular therapy (EVT) is performed with iodinated contrast agent (ICM), which can provoke potential deterioration in renal function. CO2 is a safe negative contrast agent to guide vascular procedures, but interpretation of CO2 angiography is challenging. Changes in blood flow following iodine-aided EVT are assessable with 2D-perfusion angiography (2D-PA). The aim of this study was to evaluate 2D-PA as a tool to monitor blood flow changes during CO2-aided EVT. Material and Methods 2D-PA was performed before and after ten EVTs (nine stents; one endoprosthesis; 10/2012–02/2020) in nine patients (six men; 65 ± 10y) with Fontaine stage IIb (n = 8) and IV (n = 1). A reference
& Jan B. Hinrichs [email protected] Cornelia L. A. Dewald [email protected] Lena S. Becker [email protected] Sabine K. Maschke [email protected] Timo C. Meine [email protected] Bernhard C. Meyer [email protected] Frank K. Wacker [email protected] 1
Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
ROI (ROIINFLOW) was placed in the artery before the targeted obstruction and a target ROI (ROIOUTFLOW) distally. Corresponding ROIs were used pre- and post-EVT. Time to peak (TTP), peak density (PD) and area under the curve (AUC) were computed. The reference/target ROI ratios (TTPOUTFLOW/TTPINFLOW; PDOUTFLOW/PDINFLOW; AUCOUTFLOW/AUCINFLOW) were calculated. Results 2D-PA was technically feasible in all cases. A significant increase of 82% in PDOUTFLOW/PDINFLOW (0.44 ± 0.4 to 0.8 ± 0.63; p = 0.002) and of 132% in AUCOUTFLOW/AUCINFLOW (0.34 ± 0.22 to 0.79 ± 0.59; p = 0.002) was seen. A trend for a decrease in TTPOUTFLOW/TTPINFLOW was observed (- 24%; 5.57 ± 3.66 s–4.25 ± 1.64 s; p = 0.6). Conclusion The presented 2D-PA technique facilitates the assessment of arterial flow in CO2-aided EVTs and has the potential to simplify the assessment of immediate treatment response. Keywords 2D-perfusion angiography Carbon dioxide Negative contrast agent Endovascular treatment Stent Peripheral arterial disease Abbreviations 2D-PA 2D-perfusion angiography AUC Area under the time–density curve CKD Chronic kidney disease CO2 Carbon dioxide DSA Digital subtraction angiography eGFR Estimated glomerular filtration rate EVT Endovascular therapy ICM Iodinated contrast medium PAD Peripheral arterial disease PD Peak density value ROI Region of interest
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2D-Perfusion Angiography U
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