Abstracts

RETURN TO ABSTRACT LISTING


1587. 2D-Perfusion Angiography as a Tool to Assess Instant Treatment Response During Endovascular Therapy With CO2 in Peripheral Arterial Disease
Authors * Denotes Presenting Author
  1. Cornelia Dewald *; Institute for Diagnostic and Interventional Radiology, Medical School Hannover
  2. Lena Becker; Institute for Diagnostic and Interventional Radiology, Medical School Hannover
  3. Sabine Maschke; Institute for Diagnostic and Interventional Radiology, Medical School Hannover
  4. Timo Meine; Institute for Diagnostic and Interventional Radiology, Medical School Hannover
  5. Bernhard Meyer; Institute for Diagnostic and Interventional Radiology, Medical School Hannover
  6. Frank Wacker; Institute for Diagnostic and Interventional Radiology, Medical School Hannover
  7. Jan Hinrichs; Institute for Diagnostic and Interventional Radiology, Medical School Hannover
Objective:
Patients with peripheral arterial disease (PAD) and critical limb ischemia (CLI) require urgent revascularization. Current guidelines recommend an "endovascular first“ strategy for stenosed or occluded vessels. However, endovascular therapy (EVT) is commonly performed using iodinated contrast medium (ICM), which can provoke contrast-induced nephropathy (CIN) in patients with renal failure. CO2 is long known as an alternative, safe negative contrast agent to guide vascular procedures, but the interpretation of CO2 angiographic images is challenging. 2D perfusion angiography (2D-PA) is a novel technique for the assessment of blood flow and relies on the dedicated post-processing of digital subtraction angiography (DSA) images. Aim of this study was to evaluate 2D-PA as a tool to monitor blood flow changes during CO2-aided EVT.

Materials and Methods:
2D-PA was performed during 10 EVTs (9 stents; 1 endoprothesis) in 9 patients (6 men; 65±10y; Fontain stage IIb (n=8) or IV (n=1)) between 10/2012 and 02/2020. A reference ROI (ROIINFLOW) was placed in the artery proximal to the targeted obstruction and a target ROI (ROIOUTFLOW) distal to the obstruction. Corresponding ROIs were used pre- and post-EVT. Time to peak (TTP), peak density (PD) and area-under-the-curve (AUC) were calculated. The reference/target ROI ratios (TTPOUTFLOW/TTPINFLOW; PDOUTFLOW/PDINFLOW; AUCOUTFLOW/AUCINFLOW) were computed.

Results:
2D-PA was technically feasible in all procedures. A significant increase in PDOUTFLOW/PDINFLOW of 0.44±0.4 to 0.8±0.63 (+82%; p=0.002) and in AUCOUTFLOW/AUCINFLOW of 0.34±0.22 to 0.79±0.59 (+132%; p=0.002) was observed. A trending decrease of TTPOUTFLOW/TTPINFLOW was observed (5.57±3.66s to 4.25±1.64s; -24%; p=0.6).

Conclusion:
2D-PA allows the assessment of arterial flow in CO2-aided EVTs and thus has the potential to support the evaluation of immediate treatment response.