Definition of the Ostium (Neck) of an Aneurysm Revealed by Intravascular Sonography: An Experimental Study in Canines
,
Aquilla S. Turka,
Charles M. Strother,a,
Daniel I. Crouthamela and
James A. Zagzebskia
a From the Department of Radiology, University of Wisconsin Health Sciences Center, E1/320, 600 Highland Ave, Madison, WI 53792.
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FIG 1. Digital subtraction angiogram of lateral (LA) and bifurcation (BA) aneurysms in a canine model. This image was obtained with a portable C-arm device
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FIG 2. Intravascular sonographic machine with automated pullback servo and catheters
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FIG 3. Left, Diagram of a lateral aneurysm and parent artery (dashed lines indicate locations in which intravascular sonographic measurements were made).
Center, Line drawing of sections through the parent artery and the aneurysm in the plane of intravascular sonography.
Right, Line drawing of corresponding intravascular sonograms.
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FIG 4. Left, Diagram of a bifurcation aneurysm, parent artery, and adjacent branches (dashed lines indicate locations at which intravascular sonographic measurements were made).
Center, Line drawings of sections through the parent artery, the aneurysm, and adjacent branches in the plane of intravascular sonography.
Right, Line drawing of corresponding intravascular sonograms.
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FIG 5. A, Angiogram of experimental aneurysm. The projection is optimized to allow best possible visualization of the lateral aneurysm's neck.
B, Intravascular sonogram of the parent artery that gives rise to the lateral aneurysm.
C, Intravascular sonogram through the lateral aneurysmal ostium. This image illustrates the ability to depict the width of the ostium (arrowheads indicate the point at which the lateral aneurysm, LA, joins the parent artery, PA; dashed line denotes the width of the ostium). In the intravascular sonograms, the distance between white marker dots is 1 mm and the intravascular sonographic catheter is defined by an asterisk.
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FIG 6. A, Angiogram of a lateral and a bifurcation aneurysm after treatment with GDCs. Coils are purposely positioned so as to protrude into the parent artery (arrowheads). A filling defect (arrow) along the wall of the parent artery of the lateral aneurysm represents thrombus.
B, Intravascular sonogram at the level of the filling defect on a DSA clearly shows the thrombus (arrowhead) as hyperechoic signal within the lumen.
C, Intravascular sonogram at the upper extent of the aneurysm's ostium shows coils filling the ostium (dashed line indicates limits of the aneurysmal ostium; X‘s identify the spaces between coils).
D, Intravascular sonogram at the lower extent of the aneurysm's ostium shows a portion of the outflow tract that was not occluded (X) (dashed line defines the limits of the aneurysmal ostium). In the intravascular sonograms the distance between the white marker dots is 2 mm, and the intravascular sonographic catheter is defined by an asterisk.
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FIG 7. A, Angiogram of experimental aneurysms. The projection is optimized to allow visualization of the bifurcation aneurysm's neck.
B, Intravascular sonogram in the dome of the bifurcation aneurysm (arrowheads define the wall of the aneurysm).
C, Intravascular sonogram at a location just on the aneurysm side of the ostium (Os). The adjacent right and left carotid artery branches (RCa and LCa, respectively) are seen on either side of the aneurysm's wall as hypoechoic regions (arrowheads define the wall of the aneurysm).
D, Intravascular sonogram at the isthmus between the ostium (Os) and adjacent bifurcation branches (dashed lines indicate position at which ostium opens into the bifurcation of the left and right carotid arteries, LCa and RCa, respectively). In the intravascular sonograms the distance between white marker dots is 2 mm, and the intravascular sonographic catheter is defined by an asterisk.
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FIG 8. A–D, 2D reformations of a bifurcation aneurysm in the coronal (A) and sagittal (B) planes with corresponding axial image at the ostium (C) and a DSA (D) (dashed lines indicate the limit of the ostium; BA, bifurcation aneurysm; PA, parent artery; RCa, right carotid artery; LCa, left carotid artery; Os, ostium; asterisk denotes the intravascular sonographic catheter)
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FIG 9. A, 2D reformation of a lateral aneurysm in the coronal plane. The artifact in this image is caused by up-and-down motion of the intravascular sonographic catheter during the cardiac cycle (asterisk denotes the intravascular sonographic catheter; LA, lateral aneurysm; PA, parent artery; dashed line identifies the limit of the aneurysm ostia).
B, Corresponding DSA.
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FIG 10. Regression plots of inter- and intraobserver correlation coefficients (P < .0001 in each instance)
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