A Pionner; Sven Seldinger

Sven Ivar Seldinger (1921-1998), began his medical training at the Karolinska Institute and upon graduation in 1948, he went on to specialize in radiology.  It was at the Karolinska Hospital he came up with an ingenious idea on how to introduce a catheter in an artery or vein without the need of surgically exposing the vessel of entry with a cut down.

Seldinger first published his technique in 1953 in Acta Radiologica. The technique was based on introducing a guide wire through a needle that had punctured a peripheral artery such as the femoral artery leave the guide in place, remove the needle and introduce a catheter over the wire.  Thus, he could catheterize any artery or vein by manipulating the catheter and the guide wire.  Upon the completion of the procedure digital pressure over the puncture site produced hemostasis, obviating the need to suture or ligate the vessel of entry.

The Seldinger technique is used today for diagnostic angiography, interventional procedures, insertion of central venous catheters, insertion of chest or abdominal drainage catheters, insertion of the leads of cardiac pacemakers and many other interventional procedures. 

During his lifetime he received numerous awards from American, Swedish and German medical and radiological societies for his technique that made diagnostic and interventional procedures widely available thus he revolutionized medicine at large.  In 1984 Seldinger received an honorary doctorate from the Faculty of Medicine at Uppsala University in Sweden.

Rotational Angiography in the study of Congenital Cardiac Anomalies in Children

A study by Parini et al published in Pediatric Cardiology. reports on the use of Rotational angiography (RA) for evaluating congenital heart disease (CHD) in the cardiac cath lab, permits acquisition of 3D datasets with superior spatial resolution.  The authors describe five cases on whom they created 3D-printed hearts in patients with CHD.

Diagnoses included coronary artery aneurysm, Glenn shunt, coarctation of the aorta, tetralogy of Fallot with major aortopulmonary collateral arteries (MAPCAs), and pulmonary artery stenosis. There was no significant measurement difference between RA and the printed model (r = 0.990, p < 0.01). There was also no significant inter-observer variability. 

The authors concluded that RA could generate highly accurate 3D models in congenital heart disease.  These models can be useful in patient evaluation and management.

The ENDOSTROKE Study

Singer et al in a study that was conducted at six centers and published in Radiology assessed the significance and role of collateral circulation in160 patients with proximal middle cerebral artery (MCA) occlusion; The ENDOSTROKE study.

Collateral vessel status was assessed at angiography by using the American Society of Interventional and Therapeutic Neuroradiology (ASITN) Society of Interventional Radiology (SIR) collateral vessel grading system, while using the Thrombolysis in Cerebral Infarction (TICI) scale assessed reperfusion. Good outcome was defined as a modified Rankin Scale score of 0–2 at follow-up.

Good clinical outcome was attained in 62 (39%) of the 160 patients, and TICI 2b–3 reperfusion was achieved in 94 (59%) patients. Nineteen patients had ASITN/SIR collateral vessel grades of 0 or 1, 63 patients had a grade of 2, and 78 patients had grades of 3 or 4.

Better collateral vessels were associated with higher reperfusion rates (21%, 48%, and 77% for ASITN/SIR grades of 0 or 1, 2, and 3 or 4, respectively; P < .001), a higher proportion of infarcts smaller than one-third of the MCA territory (32%, 48%, and 69% for ASITN/SIR grades of 0 or 1, 2, and 3 or 4, respectively; P < .001), and a higher proportion of good clinical outcome (11%, 35%, and 49% for ASITN/SIR grades of 0 or 1, 2, and 3 or 4, respectively; P = .007). At multivariable analysis, collateral vessel status independently predicted reperfusion, final infarct size, and clinical outcome. Within an onset-to-treatment time (OTT) of 0–3 hours, collateral vessel status predicted final infarct size and reperfusion. Within an OTT of 3–6 hours, it additionally predicted clinical outcome, with 53% of patients with ASITN/SIR grades of 3 or 4 having a good outcome, as compared with 0% of patients with grades of 0 or 1 and 27% of patients with a grade of 2 (P = .008).

The researchers concluded that collateral circulation independently predicted parameters such as reperfusion, infarct size, and clinical outcome.