Waldenberger Peter, Chemelli Andreas, Mallouhi Ammar
Department of Radiology, St. Vincent Hospital, Seilerstätte 4, 4010 Linz, Austria.
Eur Radiol. 2009 Feb;19(2):503-8. doi: 10.1007/s00330-008-1161-0. Epub 2008 Sep 16.
Three-dimensional rotational angiography (3DRA) is useful for detecting, classifying and planning treatment for intracranial aneurysms. Prolonged contrast material (CM) injection, required for 3DRA, might cause blood pressure changes in the selectively catheterized artery. The purpose of this study was to assess the extent and clinical relevance of haemodynamic changes in the selected artery during 3DRA. Twenty-five consecutive patients with intracranial aneurysms were prospectively examined with 3DRA (18 ml, 3 ml/s power injector) for planning treatment. Intra-arterial pressure was measured in the internal carotid or vertebral artery by using a pressure guidewire. Mean and systolic blood pressure acquired by the guidewire (Pd) and fractional flow reserve (FFR) were measured before, during and after CM injection. The extent of Pd and FFR changes was evaluated by Student's t-test and linear regression analysis and their clinical relevance with the limits-of-agreement analysis. Mean systolic Pd and FFR increased significantly (P<0.001) from 105.2+/-22 mmHg and 0.98+/-0.04, respectively, at the baseline to 118.1+/-23 mmHg and 1.09+/-0.12, respectively, during injection and decreased thereafter to baseline. The correlation between mean and systolic Pd during injection and at baseline was moderate (r(2)=0.47 and 0.63, respectively) but remained significant (P=0.001 and <0.001, respectively). Moderate bias and range of agreement were found for systolic Pd (12.8+/-29.2 mmHg) and FFR (0.1+/-0.24). Selective CM injection during 3DRA causes a temporary but clinically tolerable increase in blood pressure and pressure gradient.
三维旋转血管造影术（3DRA）对于颅内动脉瘤的检测、分类及治疗方案规划很有用。3DRA所需的长时间造影剂（CM）注射可能会导致选择性插管动脉的血压变化。本研究的目的是评估3DRA期间所选动脉血流动力学变化的程度及其临床相关性。对25例连续的颅内动脉瘤患者进行前瞻性3DRA检查（18 ml，3 ml/s高压注射器）以规划治疗方案。使用压力导丝测量颈内动脉或椎动脉的动脉内压力。在CM注射前、注射期间和注射后测量由导丝获取的平均血压和收缩压（Pd）以及血流储备分数（FFR）。通过学生t检验和线性回归分析评估Pd和FFR变化的程度，并通过一致性界限分析评估其临床相关性。平均收缩期Pd和FFR在基线时分别为105.2±22 mmHg和0.98±0.04，注射期间分别显著增加（P<0.001）至118.1±23 mmHg和1.09±0.12，之后降至基线。注射期间与基线时平均Pd和收缩期Pd之间的相关性为中度（r²分别为0.47和0.63），但仍具有显著性（P分别为0.001和<0.001）。发现收缩期Pd（12.8±29.2 mmHg）和FFR（0.1±0.24）存在中度偏差和一致性范围。3DRA期间的选择性CM注射会导致血压和压力梯度暂时升高，但临床上可耐受。
