Assessment of Instant Treatment Response During Endovascular Therapy With CO2 in Peripheral Arterial Disease: Is 2D-Perfusion Angiography (2D-PA) a Useful Tool?

Aims Endovascular therapy (EVT) in patients with peripheral arterial disease (PAD) is traditionally performed using iodinated contrast medium (ICM), which can provoke post-contrast acute kidney injury (PC-AKI), especially in patients with renal failure. CO2 as negative contrast agent is a safe alternative to guide vascular procedures, but the interpretation of CO2-aided images is challenging. 2D perfusion angiography (2D-PA) is a novel technique for the assessment of blood flow and relies on the dedicated post-processing of digital subtraction angiography (DSA) images. The aim of this study was to evaluate 2D-PA as a tool to monitor blood flow changes during CO2-aided EVT.

Material and Methods 2D-PA was performed during 10 EVTs (9 stents; 1 endoprothesis) in 9 patients (6 men; 65 ± 10y) with PAD between October 2012 and February 2020. A reference ROI (ROIINFLOW) was placed in the artery proximal to the targeted obstruction and a target ROI (ROIOUTFLOW) distal to the obstruction. Corresponding ROIs were used pre- and post-EVT. Area-under-the-curve (AUC), time to peak (TTP) and peak density (PD) were determined. The ratios of reference ROI and target ROI (TTPOUTFLOW/TTPINFLOW; PDOUTFLOW/PDINFLOW; AUCOUTFLOW/AUCINFLOW) were calculated.

Results An increase of 82% in PDOUTFLOW/PDINFLOW (0.4 ± 0.4 to 0.8 ± 0.63; p < 0.05) and of 132% in AUCOUTFLOW/AUCINFLOW (0.3 ± 0.2 to 0.8 ± 0.6; p < 0.05) was observed. A trending decrease of TTPOUTFLOW/TTPINFLOW was observed (5.6 ± 3.7 s to 4.3 ± 1.6 s; − 24%; p > 0.05).

Conclusions The presented 2D-PA technique allows the assessment of arterial flow in CO2-aided EVTs and thus has the potential to support the assessment of immediate treatment response.

Publication History

Article published online:
11 May 2021