A Proposed Mechanism for Transient Increases in Arterial Pressure and Flow During Angiographic Injections

Wolf, Gerald; Shaw, David D.; Baltaxe, Harold A.

doi:10.1097/00004424-197805000-00004

Cited by 17 publications

(19 citation statements)

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“…5͒ show that pulsatility is maintained during injections of contrast at a steady rate. The same phenomenon has been observed in other studies [12][13][14] even over 15 s injection periods. This observation precludes the formation and downstream travel of a slug of contrast.…”

Section: Discussionsupporting

confidence: 90%

“…13,14 As an alternative to the ejector effect explanation, such increase in flow has been attributed to a pressure rise due to a transient increase in resistance at the catheter tip because of turbulence. 13 However, the ejection velocities in that study 13 seem very high ͑minimum velocity mismatch between injectate and coflow of about 1 m/s͒. We recorded marked increases in mean flow ͑70%͒ even with marginal increases in mean pressure ͑5%͒ in vivo.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have investigated angiographic contrast injections, [8][9][10][11][12][13][14][15] but these have largely focused on hemodynamic changes during and after the injection period. To our knowledge no study has attempted to quantify the mixing process of angiographic contrast with blood under injection conditions that are similar to those used in the clinical setting.…”

Section: Introductionmentioning

confidence: 99%

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The mixability of angiographic contrast with arterial blood

et al. 2009

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The mixability of angiographic contrast with arterial blood

et al. 2009

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“…The hemodynamic behavior of angiographic contrast injection into blood vessels has been extensively studied [12]–[18]. Similar analysis has not been carried out for saline flush of blood which is done very commonly in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Effect of Saline Injection Mixing on Accuracy of Conductance Lumen Sizing of Peripheral Vessels

et al. 2013

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Transient displacement of blood in vessel lumen with saline injection is necessary in the conductance method for measurement of arterial cross-sectional area (CSA). The displacement of blood is dictated by the interactions between arterial flow hemodynamics and saline injection dynamics. The objective of the present study is to understand how the accuracy of conductance measurements is affected by the saline injection. Computational simulations were performed to assess the error in predictions of arterial CSA using conductance measurements over a range of peripheral artery diameters (i.e., 4, 7, and 10 mm) with an introducing catheter (6 Fr.) for various blood flow and saline injection rates. The simulation results were validated using the conductance measurements of the phantoms with known diameters (i.e., 7 and 10 mm). The results demonstrated that a minimum ratio of saline injection rate to blood flow rate of 3 is needed to fully displace the blood and result in accurate measurement of CSA for the peripheral artery sizes considered. Furthermore, the error was shown to be minimized as the detection electrodes are positioned between the distal to the mixing zone induced by saline injection and far downstream (4–8 cm from the injection catheter tip). The present study shows that even for the large peripheral arteries (7–10 mm) where mixing can occur, an appropriate injection rate and detection position can produce accurate measurement of lumen size.

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“…In this context, it has been shown that image contrast, blood or saline injection, into both peripheral and coronary arteries can cause blood flow changes several seconds after the injection (9,16,20,21,26,29). It has also been shown that the change of flow caused by saline or blood injection depends on the injection speed, injection quantity, type of the guide catheter, and distance between injection and flow recording site (9,29). The change in blood flow has been shown to be small within 2 s of injection (9,21).…”

Section: Discussionmentioning

confidence: 99%

New method to measure coronary velocity and coronary flow reserve

Zhang¹,

Svendsen²,

Choy³

et al. 2011

American Journal of Physiology-Heart and Circulatory Physiology

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Coronary flow reserve (CFR) is an important index of coronary microcirculatory function. The objective of this study was to validate the reproducibility and accuracy of intravascular conductance catheter-based method for measurements of baseline and hyperemic coronary flow velocity (and hence CFR). The absolute coronary blood velocity was determined by measuring the time of transit of a saline injection between two pairs of electrodes (known distance) on a conductance catheter during a routine saline injection without the need for reference flow. In vitro validation was made in the velocity range of 5 to 70 cm/s in reference to the volume collection method. In 10 swine, velocity measurements were compared with those from a flow probe in coronary arteries at different CFR attained by microsphere embolization. In vitro, the mean difference between the proposed method and volume collection was 0.7 Ϯ 1.34 cm/s for steady flow and Ϫ0.77 Ϯ 2.22 cm/s for pulsatile flow. The mean difference between duplicate measurements was 0 Ϯ 1.4 cm/s. In in vivo experiments, the flow (product of velocity and lumen cross-sectional area that is also measured by the conductance catheter) was determined in both normal and stenotic vessels and the mean difference between the proposed method and flow probe was Ϫ1 Ϯ 12 ml/min (flow ranged from 10 to 130 ml/min). For CFR, the mean difference between the two methods was 0.06 Ϯ 0.28 (range of 1 to 3). Our results demonstrate the reproducibility and accuracy of velocity and CFR measurements with a conductance catheter by use of a standard saline injection. The ability of the combined measurement of coronary lumen area (as previously validated) and current velocity and CFR measurements provides an integrative diagnostic tool for interventional cardiology.catheter; conductance ISCHEMIC HEART DISEASE is complex and often involves changes in epicardial coronary arteries and myocardial microvasculature. Coronary flow reserve (CFR, ratio of maximal to baseline flow) accounts for both epicardial and microvascular resistances (7). In the absence of epicardial artery disease, the CFR provides an index of the health of coronary microcirculation. Many patients who undergo percutaneous coronary interventions and revascularizations have low coronary flow because of both epicardial and microcirculatory disease (15,28).Several methods have been used for measuring velocity or blood flow rate in animals and humans. The intracoronary Doppler wire is a well-established method for determining blood flow velocity (3,11,19). The measurement relies on the detection of red blood cells moving past the ultrasound emitter/ receiver at the end of a guide wire. Although this method has been used clinically, it is angle dependent, and especially in disease vessels, it lacks the accuracy and reproducibility needed for a reliable diagnosis (17). The thermodilution method has also been proposed for determining blood velocity (24), but it has not garnered significant clinical utility because it requires a reference injection f...

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A Proposed Mechanism for Transient Increases in Arterial Pressure and Flow During Angiographic Injections

Cited by 17 publications

References 0 publications

The mixability of angiographic contrast with arterial blood

The mixability of angiographic contrast with arterial blood

Effect of Saline Injection Mixing on Accuracy of Conductance Lumen Sizing of Peripheral Vessels

New method to measure coronary velocity and coronary flow reserve

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