logging in or signing up Homodynamic Assessment in Renal Artery s isoic Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 222 Category: Science & Tech.. License: All Rights Reserved Like it (0) Dislike it (0) Added: September 06, 2009 This Presentation is Public Favorites: 1 Presentation Description No description available. Comments Posting comment... By: roysanjeeb (22 month(s) ago) interesting; request download Saving..... Post Reply Close Saving..... Edit Comment Close Premium member Presentation Transcript Slide 1: Homodynamic Assessment in Renal Artery stenosis Hamid Reza poorhosseini M.D Assistant professor of Tehran university of Medical sciences Tehran heart center Slide 2: RAS Renal ischemia Nephropathy ` Slide 4: The relationship between renal ischemia and Nephropathy is the most important source of ombiguity about the benefits of revascularization Slide 5: Non Invasive assessment of Renal Blood flow Slide 6: Renal blood flow & GFR evaluation TC – DTPA (split Renal function and single kidney GFR) Slide 9: Nuclear scintigraphy with 99M TC – DTPA ) is reliable for measuring fractional blood flow and when used in conjunction with 125 I – Iothalamate , allows accurate measurement of total and single kidney GFR . Slide 10: • Duplex ultrasonography • CT • MRA The non invasive option Slide 11: Doppler ultrasonography – Provides in one single stage • Anatomic information • Haemodynamic information • Functional information Slide 12: Renal perfusion • RI • Intra renal flow analysis: ≪ Tardus Parvus AT > 120 ms high probability of > 70 % stenosis AT> 80 ms => > 75 % stenosis : sens 89%, spec 98 % 2 Slide 13: Renal resistive index(RRI) Slide 14: Maximum sys. Velocity – diastolic velocity RRI=-------------------------------------------------- Maximum sys.velocity Slide 15: RRI< 0.7 is a good measure of reversibility . Although RRI > 0.8 indicate paranchymal disease , it shoulde not be used as th sole indicator of irreversible renal dysfunction Slide 16: Revascularization outcome [Length of the Kidney (< 8 cm) [RI : 1 – (VTD/VMS) • < 0,8 => angioplasty to be considered • > 0,8 => poor result after angioplasty Radermacher J et al. N Engl J Med 2001;344:410-7 Slide 17: Renal arteriogram Preservation of cortical blood flow and absence intrarenal arteriolar disease are indications of reversible renal dysfunction - Poor cortical blood flow and severe diffuse intrarenal arteriolar disease are markers of advanced nephropathy Slide 19: CTA • Improvement with multislice technique – ( contrast agent • Stenosis assessment and quantification – Sens and spec ≈ 90 % vs angiography in MIP mode – Excellent when calcification (degree of stenosis agreement ?) • Renal perfusion – Cortical atrophy evaluation – Renal length Kawashima A. RadioGraphics 2000; 20:1321–1340 Johnson et al. Radiology Mai 1999 Mounier-Vehier C.et al Am J Kidney Dis. 2002 Dec;40(6):1138-45. Slide 20: MRA • Assessment of stenosis (> 50 %) – Sens: 95 %, spec : 85 % – Trend to overestimate the degree of stenosis • Renal perfusion: – Renal length - Cortical atrophy Leung DA et al. Hypertension. 1999;33:726-731 Slide 21: Invasive Assessment of significance of RAS Slide 22: Invasive Assessment of significance of RAS 1. pressure diameter stenosis by visual estimate or quantitative angiography 2. Translesional pressure gradient 3. Fractional flow Reserve 4. Intravascular ultrasound 5. renal frame count(RFC) and Renal blush grade(RBS) Slide 23: Severity of stenosis Percent Diameter stenosis by visual estimate of quantitative angiography Slide 24: ≥70-75% Diameter stenosis (~ 85% XS area) = significant RAS Slide 26: 1. using a pressure – sensing gnidewire at baseline and after ( Ach –NTG or papaverin) induced hyperemia Translesional pressure Gradient Slide 27: 2. Catheter drive pressure gradient Slide 28: Translesional pressure gradient ( TLG ) > 20 mmHg are considered hemodynamically significant . Slide 29: FFR = Pressure distal to stenosis Pressure before th stenosis Fractional Flow Reserve Slide 32: Renal Fractional flow reseve 1.There was a poor correlation between angiographic stenosis and renal FFR. ( r= - 0.18-p = 0. 54) 2.There was an excellent correlation between renal FFR and resting mean TLG ( r= - 0. 76 – p20.001 ) and the hyperemic mean TLG( r = - 094 – p < 00001 ) Subramanian et – al catheter cardiovascular inter . 2005 Apr , 64 (4) : 480-6 Slide 34: FFR < 0.80 might predict a favorable blood pressure response to revascularization . Slide 35: Intravascular ultrasound ( IVUS ) Ivus is extremely useful for assessing vessel diameter and estimation severity in FMD patients and when Used with TLG provide useful assessment of ischemia and improvement after angioplasty . Slide 36: Renal frame count(RFC) Renal blush grade(RBG) Slide 37: Renal frame count ( RFC ) RFC : The number of cineangiographic frames taken for contrast dye to reach from the proximal of RA to the distal landmark of the smallest cortical branch ( Imaging obtained 30 frame/ seconed ) Slide 39: Renal blush Grade RBG : similar criteria used for myocardial blush and evaluated of the 2 second of initial opacification Slide 42: The patients who had a response to Renal stenting with lowering of BP had the highest baseline RFC and lowest RBG , and also had significant reduction in their RFC after stenting . You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.
Homodynamic Assessment in Renal Artery s isoic Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 222 Category: Science & Tech.. License: All Rights Reserved Like it (0) Dislike it (0) Added: September 06, 2009 This Presentation is Public Favorites: 1 Presentation Description No description available. Comments Posting comment... By: roysanjeeb (22 month(s) ago) interesting; request download Saving..... Post Reply Close Saving..... Edit Comment Close Premium member Presentation Transcript Slide 1: Homodynamic Assessment in Renal Artery stenosis Hamid Reza poorhosseini M.D Assistant professor of Tehran university of Medical sciences Tehran heart center Slide 2: RAS Renal ischemia Nephropathy ` Slide 4: The relationship between renal ischemia and Nephropathy is the most important source of ombiguity about the benefits of revascularization Slide 5: Non Invasive assessment of Renal Blood flow Slide 6: Renal blood flow & GFR evaluation TC – DTPA (split Renal function and single kidney GFR) Slide 9: Nuclear scintigraphy with 99M TC – DTPA ) is reliable for measuring fractional blood flow and when used in conjunction with 125 I – Iothalamate , allows accurate measurement of total and single kidney GFR . Slide 10: • Duplex ultrasonography • CT • MRA The non invasive option Slide 11: Doppler ultrasonography – Provides in one single stage • Anatomic information • Haemodynamic information • Functional information Slide 12: Renal perfusion • RI • Intra renal flow analysis: ≪ Tardus Parvus AT > 120 ms high probability of > 70 % stenosis AT> 80 ms => > 75 % stenosis : sens 89%, spec 98 % 2 Slide 13: Renal resistive index(RRI) Slide 14: Maximum sys. Velocity – diastolic velocity RRI=-------------------------------------------------- Maximum sys.velocity Slide 15: RRI< 0.7 is a good measure of reversibility . Although RRI > 0.8 indicate paranchymal disease , it shoulde not be used as th sole indicator of irreversible renal dysfunction Slide 16: Revascularization outcome [Length of the Kidney (< 8 cm) [RI : 1 – (VTD/VMS) • < 0,8 => angioplasty to be considered • > 0,8 => poor result after angioplasty Radermacher J et al. N Engl J Med 2001;344:410-7 Slide 17: Renal arteriogram Preservation of cortical blood flow and absence intrarenal arteriolar disease are indications of reversible renal dysfunction - Poor cortical blood flow and severe diffuse intrarenal arteriolar disease are markers of advanced nephropathy Slide 19: CTA • Improvement with multislice technique – ( contrast agent • Stenosis assessment and quantification – Sens and spec ≈ 90 % vs angiography in MIP mode – Excellent when calcification (degree of stenosis agreement ?) • Renal perfusion – Cortical atrophy evaluation – Renal length Kawashima A. RadioGraphics 2000; 20:1321–1340 Johnson et al. Radiology Mai 1999 Mounier-Vehier C.et al Am J Kidney Dis. 2002 Dec;40(6):1138-45. Slide 20: MRA • Assessment of stenosis (> 50 %) – Sens: 95 %, spec : 85 % – Trend to overestimate the degree of stenosis • Renal perfusion: – Renal length - Cortical atrophy Leung DA et al. Hypertension. 1999;33:726-731 Slide 21: Invasive Assessment of significance of RAS Slide 22: Invasive Assessment of significance of RAS 1. pressure diameter stenosis by visual estimate or quantitative angiography 2. Translesional pressure gradient 3. Fractional flow Reserve 4. Intravascular ultrasound 5. renal frame count(RFC) and Renal blush grade(RBS) Slide 23: Severity of stenosis Percent Diameter stenosis by visual estimate of quantitative angiography Slide 24: ≥70-75% Diameter stenosis (~ 85% XS area) = significant RAS Slide 26: 1. using a pressure – sensing gnidewire at baseline and after ( Ach –NTG or papaverin) induced hyperemia Translesional pressure Gradient Slide 27: 2. Catheter drive pressure gradient Slide 28: Translesional pressure gradient ( TLG ) > 20 mmHg are considered hemodynamically significant . Slide 29: FFR = Pressure distal to stenosis Pressure before th stenosis Fractional Flow Reserve Slide 32: Renal Fractional flow reseve 1.There was a poor correlation between angiographic stenosis and renal FFR. ( r= - 0.18-p = 0. 54) 2.There was an excellent correlation between renal FFR and resting mean TLG ( r= - 0. 76 – p20.001 ) and the hyperemic mean TLG( r = - 094 – p < 00001 ) Subramanian et – al catheter cardiovascular inter . 2005 Apr , 64 (4) : 480-6 Slide 34: FFR < 0.80 might predict a favorable blood pressure response to revascularization . Slide 35: Intravascular ultrasound ( IVUS ) Ivus is extremely useful for assessing vessel diameter and estimation severity in FMD patients and when Used with TLG provide useful assessment of ischemia and improvement after angioplasty . Slide 36: Renal frame count(RFC) Renal blush grade(RBG) Slide 37: Renal frame count ( RFC ) RFC : The number of cineangiographic frames taken for contrast dye to reach from the proximal of RA to the distal landmark of the smallest cortical branch ( Imaging obtained 30 frame/ seconed ) Slide 39: Renal blush Grade RBG : similar criteria used for myocardial blush and evaluated of the 2 second of initial opacification Slide 42: The patients who had a response to Renal stenting with lowering of BP had the highest baseline RFC and lowest RBG , and also had significant reduction in their RFC after stenting .