Republished: Successful treatment of direct carotid-cavernous fistula in a patient with Ehlers-Danlos syndrome type IV without arterial puncture: the transvenous triple-overlay embolization (TAILOREd) technique.

We report successful transvenous treatment of direct carotid-cavernous fistula in a patient with Ehlers-Danlos syndrome type IV using a novel triple-overlay embolization (TAILOREd) technique without the need for arterial puncture, which is known to be highly risky in this patient group. The TAILOREd technique allowed for successful treatment using preoperative MR angiography as a three-dimensional overlay roadmap combined with cone beam CT and live fluoroscopy, precluding the need for an arterial puncture.

Successful treatment of direct carotid-cavernous fistula in a patient with Ehlers-Danlos syndrome type IV without arterial puncture: the transvenous triple-overlay embolization (TAILOREd) technique.

We report successful transvenous treatment of direct carotid-cavernous fistula in a patient with Ehlers-Danlos syndrome type IV using a novel triple-overlay embolization (TAILOREd) technique without the need for arterial puncture, which is known to be highly risky in this patient group. The TAILOREd technique allowed for successful treatment using preoperative MR angiography as a three-dimensional overlay roadmap combined with cone beam CT and live fluoroscopy, precluding the need for an arterial puncture.

Safety and efficacy of dual-axis rotational coronary angiography vs. standard coronary angiography.

Objective: To determine the safety and efficacy of dual-axis rotational coronary angiography (DARCA) by directly comparing it to standard coronary angiography (SA).

Background: Standard coronary angiography (SA) requires numerous fixed static images of the coronary tree and has multiple well-documented limitations. Dual-axis rotational coronary angiography (DARCA) is a new rotational acquisition technique that entails simultaneous LAO/RAO and cranial/caudal gantry movement.

Projection-based motion compensation and reconstruction of coronary segments and cardiac implantable devices using rotational X-ray angiography.

Cardiologists use two-dimensional projection images in conventional X-ray coronary angiography for the assessment of three-dimensional structures. During minimally invasive interventions there is a need to clearly visualize and analyze contrast filled coronary arteries, surrounding tissue, and implanted devices. Three-dimensional reconstruction of these structures is challenging due to the cardiac and respiratory motion.

Coronary computed tomographic angiography in the cardiac catheterization laboratory: current applications and future developments.

The last few years have seen a marked increase in the number of cardiac CT scans performed, regardless of reimbursement issues and concerns about radiation dose. New-generation multidetector CT (MDCT) scanners with wide craniocaudal coverage (256 slices and beyond) have the potential to further improve diagnostic capability compared with that of the existing generation of MDCT scanners. New dose-reduction technologies are now available on these scanners, enabling high-quality coronary imaging with a significant reduction in radiation dose.

Rotational vs. standard coronary angiography: an image content analysis.

Objective: To evaluate the clinical utility of images acquired from rotational coronary angiographic (RA) acquisitions compared to standard "fixed" coronary angiography (SA).

Background: RA is a novel angiographic modality that has been enabled by new gantry systems that allow calibrated automatic angiographic rotations and has been shown to reduce radiation and contrast exposure compared to SA. RA provides a dynamic multiple-angle perspective of the coronaries during a single contrast injection.

Enhanced stent visualization: a case series demonstrating practical applications during PCI.

Background: Visualization of coronary stents is increasingly challenging due to the reduction in stent strut thickness to improve deliverability. On the other hand stent expansion and precise implantation in the target vessel are important in optimizing short and long-term outcomes of stent-based revascularization. Stentboost Subtract is a novel X-ray technique that improves visualization of deployed stents in the coronary arteries.

Determination of optimal viewing regions for X-ray coronary angiography based on a quantitative analysis of 3D reconstructed models.

Current expert-recommended views for coronary angiography are based on heuristic experience and have not been scientifically studied. We sought to identify optimal viewing regions for first and second order vessel segments of the coronary arteries that provide optimal diagnostic value in terms of minimizing vessel foreshortening and overlap. Using orthogonal 2D images of the coronary tree, 3D models were created from which patient-specific optimal view maps (OVM) allowing quantitative assessment of vessel foreshortening and overlap were generated.

The effect of automated marker detection on in vivo volumetric stent reconstruction.

New drug eluting stents are less radiopaque than bare metal stents and therefore difficult to see with conventional X-ray coronary angiography. 2D StentBoost and intravascular ultrasound (IVUS) are routinely used to evaluate stent deployment and vessel apposition during a percutaneous coronary intervention. IVUS images give cross-sectional information about the stent lumen and surrounding tissue.

Rapid prototyping: a new tool in understanding and treating structural heart disease.

As the appreciation of structural heart disease in children and adults has increased and as catheter-based closure procedures are now being performed in clinical practice, cardiovascular physicians have multiple compelling new reasons to better understand cardiac anatomic and spatial relationships. Current 2-dimensional imaging techniques remain limited both in their ability to represent the complex 3-dimensional relationships present in structural heart disease and in their capacity to adequately facilitate often complex corrective procedures. This review discusses the cardiovascular applications of rapid prototyping, a new technology that may not only play a significant role in the planning of catheter-based interventions but also may serve as a valuable educational tool to enhance the medical community's understanding of the many forms of structural heart disease.

On-line multi-slice computed tomography interactive overlay with conventional X-ray: a new and advanced imaging fusion concept.

Background: Computed tomography (CT) has revolutionized noninvasive cardiovascular evaluations. Complicated percutaneous procedures require precise imaging guidance that conventional X-ray is often unable to provide. By combining X-ray imaging with real-time, interactive, CT-based landmarks, interventional procedures could be facilitated.

3D reconstruction of coronary stents in vivo based on motion compensated X-ray angiograms.

A new method is introduce for the three-dimensional (3D) reconstruction of the coronary stents in-vivo utilizing two-dimensional projection images acquired during rotational angiography (RA). The method is based on the application of motion compensated techniques to the acquired angiograms resulting in a temporal snapshot of the stent within the cardiac cycle. For the first time results of 3D reconstructed coronary stents in vivo, with high spatial resolution are presented.

Initial clinical experience of selective coronary angiography using one prolonged injection and a 180 degrees rotational trajectory.

Objective: Evaluate the safety of prolonged coronary injections during a rotational acquisition covering 180 degrees.

Background: Rotational angiography has been adapted to coronary angiography and shown to reduce radiation and contrast exposure. Three-dimensional (3D) reconstructions and other advanced applications require imaging over a 180 degrees -arc with a single but longer injection of larger contrast volumes.

Rotational angiography (RA) and three-dimensional imaging (3-DRA): an available clinical tool.

Being able to accurately choose an optimal view for stent positioning, non foreshortened length and to avoid side branches is imperative during therapeutic procedures. Traditional imaging limitations may include the selection of an incorrectly sized stent, inaccurate placement, and/or the need for additional stents. With the use of newer acquisition techniques and three-dimensional (3-D) modeling/reconstructions this can be minimized.

Randomized study of the safety and clinical utility of rotational angiography versus standard angiography in the diagnosis of coronary artery disease.

This study evaluates the safety and clinical utility of rotational angiography in the diagnosis of coronary artery disease. High-speed rotational angiography is a newly available angiographic modality that gives a dynamic multiple-angle perspective of the coronary tree during a single contrast injection. We prospectively randomized 56 patients referred for diagnostic coronary angiography to either standard or rotational angiography.

Multiscale vessel tracking.

A method is presented that uses a vectorial multiscale feature image for wave front propagation between two or more user defined points to retrieve the central axis of tubular objects in digital images. Its implicit scale selection mechanism makes the method more robust to overlap and to the presence of adjacent structures than conventional techniques that propagate a wave front over a scalar image representing the maximum of a range of filters. The method is shown to retain its potential to cope with severe stenoses or imaging artifacts and objects with varying widths in simulated and actual two-dimensional angiographic images.

Intra-procedural coronary intervention planning using hybrid 3-dimensional reconstruction techniques.

Rationale And Objectives: The purpose of this study was to develop a method to assist the cardiologist in planning an interventional procedure while the patient is on the catheterization table.

Materials And Methods: A rotational single plane x-ray system is used to acquire images while rapidly rotating the C-arm around the patient. Based on electrocardiogram-selected projections, both a volumetric cone-beam reconstruction of the coronary tree as well as a three-dimensional model of the vessel segment of interest is generated.

Blood pool contrast-enhanced MRA: improved arterial visualization in the steady state.

Blood pool agents (BPAs) for contrast-enhanced magnetic resonance angiography (CE-MRA) allow prolonged imaging during the steady state when the agent is distributed through the complete vascular system. This increases both the spatial resolution and the contrast resolution. However, simultaneous venous and arterial enhancement hampers interpretation.

3D MRA coronary axis determination using a minimum cost path approach.

A method is introduced to automatically find the coronary axis based on two or more user-defined points, even in the presence of a severe stenosis. The coronary axis is determined by finding a minimum cost path (MCP) in a feature image in which the tubular-like structures are enhanced. The results of the proposed method were compared with manually drawn central axes to estimate the accuracy.