Pump injector system applied to targeted post-mortem coronary artery angiography

Abstract

Targeted post-mortem computed tomography angiography (PMCTA) is one of several methods described that can be used to investigate the coronary arteries after death. Previously, this particular method has involved the manual injection of contrast media. However, manual systems do not mimic physiological conditions (arterial pressure) and may not provide optimal contrast, as iodinated contrast medium dissipates rapidly from the intra- to the extra-vascular space. To try and overcome these problems, we now report the use of a clinical automatic pump injector for targeted PMCTA. We present our final protocol for this pump system developed from experience of 74 cases, showing how these clinical pumps can be translated from clinical into autopsy practice for the injection of air and positive contrast media to visualise the coronary arteries of cadavers.

Advances in post-mortem CT-angiography

“…This aims, similar to the dynamic phase of MPMCTA, to mimic physiological pressure and provide a more meaningful assessment of vessel stenosis. 54,55 As positive contrast agents, both methods use clinical contrast agents dissolved in water, rendering them hypo-osmolar. Probably thanks to the small quantity of contrast agent used for TCA, there is no important tissue oedema observed that could affect further investigations such as histological analysis.…”

“…Probably thanks to the small quantity of contrast agent used for TCA, there is no important tissue oedema observed that could affect further investigations such as histological analysis. 55 Both methods are declared to be fast and easy to perform as well as cost effective. 52,53 First scientific studies investigating the performance of TCA have been already published, comparing the technique with autopsy 54,56 and histological investigations of coronary arteries.…”

Post-mortem imaging in sudden death cases due to arterial or cardiac hemorrhage

“…There are also reports referring to evaluation and visualization in cases after medical interventions related to the heart and great vessels [17,18]. The publications are aimed not only at diagnostic efficiency but also present different methods of CA administration [10,19,20] with the propositions of standardized protocols [4,21]. As we understand that there are no universal "remedies" for evaluation of all cases, the advances and limitations in the development of examination methods with the use of administration of CA to cadavers were discussed [22,23].…”

Adult post-mortem imaging in traumatic and cardiorespiratory death and its relation to clinical radiological imaging

“…47,56 The benefits of examining vessels under pressure during autopsy, and therefore mimicking normal physiological conditions, are well recognized but rarely performed in standard pathological practice. 57 This raises a major question to post-mortem practice; how to interpret the significance of stenosis of the coronary arteries at post-mortem examination.…”

“…64 These techniques can be translated into post-mortem investigation, particularly if the coronary arteries are examined under controlled pressure. 56 It is possible to insert catheters into the coronary arteries in cadavers, including a "pressure wire" to measure intraluminal pressure and an optical coherence tomography (OCT) catheter to provide high-resolution "virtual histology" coronary images. 65 Intravascular ultrasound could also be used.…”