Clinical Application Of Color Marker Quantitative Digital Subtraction Angiography In Arterial Disease

Objective:To evaluate clinical diagnosis values of the quantitative parameters acquired from Color Coded Quantitative Digital Subtraction Angiography (CCQ-DSA) by modified protocol of cerebral artery angiography for short-term effectiveness of Carotid Artery Stenting (CAS) and evaluate predictive value of these parameters for Cerebral Hyperperfusion Syndrome (CHS) after CAS.Methods:Forty-eight patients with unilateral asymptomatic severe carotid artery stenosis were studied during August 2013 to August 2015. Common clinical data were collected, carotid stents were implanted in accordance with standard procedures and whole cerebral angiography were preformed before and after stent implantation. Image data were analyzed by Syngo iFlow (Siemens Healthcare GmbH, Erlangen, Germany). Seventeen regions of interest (common carotid artery, C 1 and C2 segments of internal carotid artery, M1, M2 and M3 segments of middle cerebral artery, A1, A2 and A3 segments of anterior cerebral artery, ophthalmic artery, internal cerebral vein, middle cerebral artery supply area and ophthalmic artery supply area) were defined at the images of CCQ-DSA. The data of peak ratio (PR), peak time (PT) and area under the curve ratio (AUCR) from these regions of interest were analyzed. Correlations of CCQ-DSA parameters and postoperative and long-term prognosis were studied for each patient.Results:Forty-eight cases of carotid artery stenting were performed. All carotid artery stents were implanted successfully and all distal embolic protective devices were retrieved successfully. Incidence of cumulative major adverse events (death, myocardial infarction or stroke) within 30 days was 0. Adverse events within 30 days included: intraoperative transient ischemic attack (TIA) 2.1% (1/48 cases), acute coronary syndrome (ACS) 2.1% (1/48 cases) and cerebral hyperperfusion syndrome (CHS) 10.4% (5/48 cases). Follow-up rate was 93.7% and follow-up period was 17.6 (4 to 33) months in average. In the follow-up period, incidence of cumulative major adverse events was 8.3%, including:death 2.1% (1/48 cases), target vessel restenosis≥70% 4.1% (2/48 cases), myocardial infarction 2.1% (1/48 cases). CCQ-DSA Results:1) visual evaluation: in the carotid artery blood supply region, the developing region of red expanded after stent implantation. The anterior cerebral artery, which was missing before stenting, was re-developed after stent implantation in some pateints12.5% (6/48 cases).2) Blood flow parameters:(1) Peak ratio (PR) in the following regions of interest (ROI) increased after stent implantation (P<0.05):C1and C2 segments of internal carotid artery, M1, M2 and M3 segments of middle cerebral artery, A1, A2 and A3 segments of anterior cerebral artery, internal cerebral vein in AP view and middle cerebral artery supply area. (2) Peak time (PT) shortened in the following regions of interest after stent implantation (P<0.05): C1and C2 segments of internal carotid artery, M1, M2 and M3 segments of middle cerebral artery, A1, A2 and A3 segments of anterior cerebral artery, ophthalmic artery, internal cerebral vein. (3) Area under the curve ratio (AUCR) increased in the following regions of interest after stent implantation (P<0.05):middle cerebral artery supply area, M1, M2 and M3 segments of middle cerebral artery, A1, A2 and A3 segments of anterior cerebral artery. (4) Difference of relative peak time (ArPT) of C2 segment of internal carotid artery at AP view and internal carotid vein (AP7_ICV and La8_ICV) were meaningful indicators for detection of residual stenosis≥30% after stent implantation (P <0.05). The area under the receiver operating characteristic (ROC) curve were 0.778, 0.875 and 0.752 on AP3_C2, AP7_ICV and La8_ICV, respectively. The cut-off point of AP3_C2 was 0.135s, with a sensitivity of 66.7% and a specificity of 95.2%. The cut-off point of AP7_ICV was 0.065s, with a sensitivity of 100% and a specificity of 78.6%. The cut-off point of La8_ICV was-0.005s, with a sensitivity of 100% and specificity of 64.3%. (5) The most meaningful indicator for predict cerebral hyperperfusion syndrome was the increase ratio of AUCR on AP8_RM (P<0.05), which area under the ROC curve was 0.93. The cut-off point was 29.29%, with a sensitivity of 100% and a specificity of 90.7%.Conclusion:Carotid artery stenting is a safe and effective method of treating asymptomatic unilateral severe carotid artery stenosis. The images and quantitative parameters of CCQ-DSA can be used to assess the improvement of cerebral blood flow after carotid artery stenting. The increase ratio of AUCR can be used to predict occurrence cerebral hyperperfusion syndrome after carotid stenting.Objective:To determine risk factors of overt/non-overt disseminated intravascular coagulation (DIC) in abdominal aortic aneurysm (AAA) patients undergoing endovascular aneurysm repair (EVAR).Methods:In a retrospective study,117 patients undergoing selective EVAR for AAA were investigated for overt/non-overt DIC from June 1st 2013 to December 31 2014. The following parameters were reviewed:D-dimer, Platelet count, fibrinogen and prothrombin time (PT) at before operation and 1,2, and 7 days after operation. Overt DIC was defined as International Society on Thrombosis and Hemostasis (ISTH) DIC score≥5. Non-overt DIC was defined as Non-overt DIC score≥5. Factors associated with overt/non-overt DIC were identified by stepwise Logistic regression.Results:Among 117 patients, who received EVAR for AAA,3 patients (2.5%) were diagnosed as overt DIC and 31 patients (26.5%) were diagnosed as non-overt DIC. Univariate analysis showed significant risk factors for overt/non-overt DIC were aging, operating duration, blood loss, renal dysfunction and endoleak (P<0.05). Stepwise Logistic regression showed that independent risk factors for overt/non-overt DIC were endoleak (B=2.118, S.E.=0.917, Wald=5.335,P=0.021), renal dysfunction (B=2.135, S.E.=0.797, Wald=7.183,P=0.007) and operating duration (B=0.021, S.E.= 0.006, Wald= 11.126, P=0.001).Conclusion:Independent risk factors for non-overt DIC in patients who received EVAR for AAA are endoleak, renal dysfunction and operating duration.