Innova 3D clinical benefits for vascular interventions

Courtesy of Dr O.François,
Head of Department Interventional Radiology
General Hospital ASZ Aalst, Belgium

The General Hospital ASZ in Aalst, Belgium is equipped with the Innova 3100IQ digital flat panel angiography system. The Innova 3100IQ system, installed by GE Healthcare has a 30cmx30cm digital detector designed to perform interventional procedures in radiology, neuroradiology and cardiology. Digital subtraction angiography (DSA), 3D Angiography and 3D CT imaging modalities were used to fully understand the following case study.


The Clinical case below is displayed only for educational purpose and for the benefit of healthcare student and professional

Patient History

A 45-y-old man suffered from severe right sided headache since a few days. No other neurological abnormalities were found with clinical examination by a staff neurologist.
A CT-scan of the brain was performed to exclude an intracranial haemorrhage.
There was no intracranial bleeding, but the contrast enhanced CT scan (CECT) revealed a dissection of the right internal carotid artery (RICA).

Procedure and discussion

	Fig.1: 64-slice-CT axial view at carotid channel level. It shows the absence of luminal contrast in the RICA.		Fig.2: Curved planar reconstruction is highly suggestive for complete occlusion of the petrosal part of the RICA.
	Fig.3: DSA, showing the lateral view of the RICA.		Fig.4: Innova 3D VR showing the RICA.
	Fig.5: Innova 3D MIP Showing the dissection		Fig.6: Innova 3D VR Showing the re-entry point
	Fig.7: Axial view: True lumen (in black) and rim of contrast on the false lumen

The initial CECT, performed on 64-slice CT, was imported on the multi-modality Advantage WorkstationTM Volume Share 2 and postprocessed. (Fig.1 and Fig.2). On the axial and curved planar reconstructions of the RICA, it was not possible to see whether the lumen was partially or completely occluded by the dissection.
A DSA acquisition was performed to evaluate the patency of the RICA, the extent of the dissection and the direction of the intracranial flow. Using a right femoral approach, a 4F Berenstein catheter (Angiodynamics, Queensbury, NY) was selectively placed in the right common carotid artery. The acquisition was performed (Fig. 3) with 10 cc of contrast media (300 mg I/ml) at 5 cc/s. After sub selective placement of the catheter at the origin of the RICA, an Innova 3D acquisition is launched at 40°/s, using 16 cc of contrast media (300 mg I/ml) at 4 cc/s and an X-ray delay of 1 second. On the AW, the 3D images were processed with 3D Volume Rendering (3DVR) (Fig.4 and Fig.6) and Maximal Intensity Projection (MIP) (Fig.5), through the dissection of the RICA and 3D CT images in axial plane (Fig.7) The origin of the dissection is seen in the distal segment of the cervical, extracranial internal carotid artery. The false lumen, created by the dissection of the vessel wall has a re-entry in the true lumen of the RICA in the carotid channel of the petrosal bone.
This re-entry point is clearly depicted on the axial thin MIP reconstruction images.

Conclusion

In this case the high quality of the 3DVR and axial cross-section images acquired with the Innova 3D acquisition gives an accurate and precise anatomical and diagnostic information on the dissection and vessel wall (re-entry) in planning an eventual endovascular treatment. The Innova 3D acquisition with intra-arterial contrast injection in the RICA provides more and (extra)luminal information in comparison with a intravenous 64-slice CECT scan in eligible patients for interventional neurovascular procedures.