Keywords:
Cardiac, Arteries / Aorta, Cardiovascular system, Catheter arteriography, CT-Angiography, MR-Angiography, Arterial access, Cost-effectiveness, Aneurysms, Blood, Cardiac Assist Devices, Retrospective, Observational, Performed at one institution
Authors:
F. Di Tosto1, M. Chiocchi1, L. Pugliese2, F. Ricci2, A. U. Cavallo1, M. Forcina2, V. De Stasio1, M. Presicce1, L. Spiritigliozzi2, R. Floris1; 1Rome/IT, 2Roma/IT
DOI:
10.26044/ecr2020/C-10631
Methods and materials
Between June 2017 and January 2019, 323 patients with severe aortic stenosis, not eligible for surgery, were enrolled for TAVI at the Interventional Cardiology Department of Tor Vergata Polyclinic. All patients underwent preprocedural diagnostic examination: 218 patients without chronic kidney disease were examined by 128-slice CT system using a retrospectively ECG-triggered high-pitch spiral acquisition mode with low-dose radiation, other 105 patients with chronic kidney disease were divided in two groups: 78 patients with 30 ml/min < eGFR < 45 ml/min were studied by a CT acquisition protocol with low-dose contrast injections and 27 patients with eGFR < 30 ml/min underwent MRI assessment without contrast media administration.
The Contrast Media (CM) used in CT was a non ionic, iso-osmolar contrast agent with an iodine concentration of 400 mg/mL, injected into an antecubital vein through a 20-gauge catheter using a dual-shot injector.
CT acquisition protocol with low-dose contrast injections was performed with a multiphasic injection protocol. The total amount of CM was adapted to the patient’s BMI and was administered with five boluses at different flow rates, resulting in a total of 40-55 mL at an average infusion rate of 3.5 mL/s Table 1 .
All CT images of the aortic root [1, 2], the abdominal aorta and iliac and femoral arteries [3] were transferred to a dedicated workstation for post-processing analysis with dedicated software (Aortic root: CardIQ X-Press, Vessels Analysis: CardioQ3 package; GE Healthcare) Fig. 1 .
MRI protocol is acquired on a 1,5T system and based on balanced Steady-State Free Precession (SSFP) sequences or balanced Fast-Field Echo (FFE) sequences, which offer high signal-to-noise ratio and good contrast between blood pool and vascular tree or myocardium Table 2 [4]. After some acquisitions we obtained the two perpendicular planes on the aortic root and on the ascending aorta that allowed us to make the measurements we needed Fig. 2 Fig. 3 .