CTA For IM
CTA For IM
CTA For IM
CT ANGIOGRAPHY
COMPUTED TOMOGRAPHIC
ANGIOGRAPHY
Evaluation of the vascular system
CT scan
▪ Readily available – 24/7
▪ Patient comfort
▪ Fast scan time
▪ Open gantry –claustrophobia is less of an issue
† Ionizing radiation
Non-ionic iodinated intravenous contrast material
† Allergic/contrast induced reactions
† Acute renal failure
COMPUTED TOMOGRAPHIC
ANGIOGRAPHY
Evaluation of the vascular system
Minimally invasive
▪ Large bore venous access
▪ Ga 20 or bigger
▪ Antecubital vein
Right – for pulmonary arteriogram
† Risk of contrast extravasation
▪ High flow rate of contrast administration
Arterial and venous systems
COMPUTED TOMOGRAPHIC
ANGIOGRAPHY
Evaluation of the vascular system
Anatomic body scan
▪ Other etiologies can be assessed for patient’s symptoms
▪ “Incidentalomas”
▪ Other pertinent structures can be evaluated
▪ Deeper structures are addressed
▪ Not readily seen in duplex studies
▪ Ideal imaging modality in evaluating post operative
interventions
COMPUTED TOMOGRAPHIC
ANGIOGRAPHY
Versus Conventional Catheter Angiography
▪ Anatomic body scan
▪ Other etiologies can be assessed for patient’s symptoms
▪ “Incidentalomas”
▪ Other pertinent structures can be evaluated
▪ Deeper structures are addressed
▪ Ideal imaging modality in evaluating of post operative interventions
▪ Less radiation exposure
▪ Less risk of bleeding and catheter-related iatrogenic
injuries
▪ Diagnostic
COMPUTED TOMOGRAPHIC
ANGIOGRAPHY
Versus Conventional Catheter Angiography
▪ Comparable sensitivity and specificity
▪ 4-vessel angiogram
▪ Carotid and verterbal arteriogram
▪ Aortogram
▪ Renal artery angiogram
▪ Pulmonary arteriogram
COMPUTED TOMOGRAPHIC
ANGIOGRAPHY
Versus Conventional Catheter Angiography
▪ Coronary arteries
▪ High negative predictive value
▪ Better evaluation of fistulas and sinuses
▪ Better pick up of myocardial bridging
▪ Soft and vulnerable plaques
† Arrhythmias
† Heart rate > 80 or 90 beats per minute
† Calcium score of > 400
Proximal RCA and LAD
LM
COMPUTED TOMOGRAPHIC
ANGIOGRAPHY
GENERAL PREPARATIONS
General Preparations
NPO for at least 4 hours
Serum creatinine (7-10 days)
If elevated, clear with AP and/or attending
nephrologist
Determine creatinine clearance
Better if patient will undergo scheduled or STAT
dialysis on the day or immediately after the
procedure
Clear with AP's and informed consent if STAT
procedure
General Preparations
Creatinine clearance
Cockcroft-Gault Formula
▪ 140-Age x Mass (kg.) x 0.85 (if female)
----------------------------------------------
72 x serum creatinine (mg./dL)
Normal values
▪ Male: 55-146 mL./min.
▪ Female: 52-134 mL./min.
General Preparations
Large bore antecubital venous access Ga. 20
or bigger
If < Ga. 20, decrease flow rate (not < 3 mL/sec)
and increase HU threshold (at least 120 HU)
Possibility of acquiring suboptimal images
precluding adequate evaluation
Retrieve and review all previous pertinent
imaging studies done on the patient
General Preparations
Special considerations
Contemplated RAIU studies
▪ Iodinated IV contrast will interfere with future RAIU for the next three
months
▪ It decreases thyroid uptake of the I-138
Renal impairment
▪ Renal failure
Allergic/asthmatic patients
▪ Exacerbations
Post chemotherapy patients
▪ Fragile peripheral venous structures
▪ Difficulty of line insertion
CORONARY CTA
PREPARATIONS
Coronary CTA Preparations
For coronary CTA, heart rate should not be > 70
bpm and no arrhythmia
Prepare Isordil (nitrate) 5 mg SL to be given to patient
while inside the CT scan unit – for dilatation of the
coronary arteries hence better visualization and
evaluability
▪ If OPD, monitor BP and HR for at least an hour before
sending patient home
Retrieve/review all previous CT or conventional
coronary angiography studies, ECG results, 2D
echo, stress test (conventional and nuclear)
Coronary CTA Preparations
If out patient
Refer back to attending cardiologist and inform
Drs. To and Almajar for Co-reading
If no in-house attending cardiologist, we still
inform Drs. To and Almajar
▪ If no contraindications to beta blockers (COPD, Asthma)
▪ Give Metoprolol 50 mg. PO night before and 3 to 4 hours before
the procedure
▪ If with contraindications
▪ Give Verapamil 80 mg 3 to 4 hours before the procedure (Watch
out for hypotension, determine baseline BP)
Coronary CTA Preparations
4 vessel CTA
Stenosis and aneurysms
Fistulas
Collaterals
▪ Locator: Proximal ICA or distal CCA (C4 level)
▪ 60 mL. contrast/30 mL. saline chaser @ 5 mL/sec
more medially placed
usually smaller in
caliber
more round in
configuration
level of C4 vertebral
carotid C4 body
pyriform sinus level
jugular
Head/Circle of Willis CTA
NEURO 4D
CORONARY ANGIOGRAPHY
Coronary CTA