Department of Cardiovascular Sciences, Vascular Unit, Gemelli Foundation, Catholic University of the Sacred Heart, School of Medicine, Rome, Italy.
Eur Rev Med Pharmacol Sci. 2018 Jan;22(2):516-522. doi: 10.26355/eurrev_201801_14204.
To evaluate the role of quantitative digital subtraction angiography (Q-DSA) with parametric color coding (PCC) in assessing patients with type B chronic thoracic aortic dissection (TBCAD) during thoracic endovascular aortic repair (TEVAR) procedures.
A total of 11 patients electively treated in our Department for a TBCAD were retrospectively enrolled. All cases were treated with TEVAR for false lumen aneurysm of the thoracic descending aorta. For digital subtraction angiography (DSA) series post-processing, a newly implemented PCC algorithm was used to turn consecutive two-dimensional images into a single color-coded picture (syngo iFLOW, Siemens AG, Forchheim, Germany). In consensus reading, two clinicians experienced in vascular imaging evaluated the DSA series in blinded assessment and compared them to the color-coded images. PCC was assessed for its accuracy in identifying the true and false lumen as well as whether it could provide improved visualization in pre-deployment stent grafting and the final evaluation of treatment.
PCC facilitated the visualization of the aortic dissection angioarchitecture in terms of contemporary true and false lumen vision in 81.8% of the cases. In 72.7% of the procedures, Q-DSA was estimated to improve aorta information assessment in terms of false lumen viewing, and it was possible to identify the proximal entry tear position in 45.4% of the cases. After stent graft deployment, in 72.7% of the cases (all 8 patients in which the aortic arch false lumen was visible in pre-treatment), Q-DSA confirmed the absence of early false lumen reperfusion.
Our results indicate that Q-DSA could be useful in the intraprocedural evaluation of patients with aortic dissection during TEVAR procedures without additional x-ray costs and contrast exposure.
评估定量数字减影血管造影（Q-DSA）结合参数彩色编码（PCC）在胸主动脉腔内修复术（TEVAR）治疗 B 型慢性胸主动脉夹层（TBCAD）患者中的作用。
回顾性纳入我科 11 例 TBCAD 患者，均因胸降主动脉假腔动脉瘤行 TEVAR 治疗。对数字减影血管造影（DSA）系列进行后处理，采用新实施的 PCC 算法将连续二维图像转化为单彩色编码图像（syngo iFLOW，西门子股份公司，Forchheim，德国）。在共识阅读中，两名具有血管成像经验的临床医生进行盲法评估，比较 DSA 系列与彩色编码图像。评估 PCC 在识别真假腔方面的准确性，以及它是否可以在支架置入前提供更好的可视化效果，并对治疗的最终效果进行评估。
PCC 使 81.8%的病例能够更直观地观察主动脉夹层的血管结构，从而显示真假腔。72.7%的病例认为 Q-DSA 可以改善对假腔的评估，45.4%的病例可以确定近端入口撕裂的位置。支架置入后，72.7%的病例（所有 8 例术前可见主动脉弓假腔的病例）Q-DSA 证实早期假腔再通不存在。
我们的研究结果表明，Q-DSA 可以在 TEVAR 治疗过程中对主动脉夹层患者进行术中评估，而不会增加 X 线辐射和造影剂暴露。
