How can an angiogram video be analyzed?

Analysis of Angiogram Videos: Advanced Imaging Techniques for Vascular Assessment

Angiogram videos should be analyzed using a structured approach that combines qualitative visual assessment and quantitative measurements to evaluate vascular anatomy, blood flow dynamics, and pathological findings to guide clinical decision-making.

Types of Angiography and Their Analysis

Conventional Angiography

• Considered the gold standard for vascular imaging with highest spatial resolution 1
• Involves catheter insertion with direct contrast injection
• Analysis includes:
  • Vessel lumen patency and diameter measurements
  • Identification of stenosis, occlusions, or aneurysms
  • Assessment of collateral circulation
  • Evaluation of blood flow dynamics
  • Detection of small vessel abnormalities

CT Angiography (CTA)

• Uses timed contrast injection with thin-section acquisition 1
• Analysis should include:
  • 3D reconstructions and multiplanar reformatting
  • Vessel wall assessment (not just lumen)
  • Detection of calcifications and soft plaque
  • Evaluation of surrounding structures
  • Can detect bleeding as slow as 0.3 mL/min 2, 1

Magnetic Resonance Angiography (MRA)

• Can be performed using time-of-flight or phase-contrast techniques 1
• No ionizing radiation exposure
• Analysis focuses on:
  • Flow dynamics
  • Vessel wall characteristics
  • Surrounding tissue evaluation
  • Integration with cardiac function assessment

Specialized Analysis Techniques by Vascular Region

Coronary Angiography Analysis

• Intravascular imaging is strongly recommended as an essential adjunct to angiography for specific lesion subsets (left main, proximal LAD, in-stent restenosis, calcified arteries) 2
• Analysis should include:
  • Lesion morphology and severity classification
  • TIMI flow grading (0-3)
  • Collateral circulation assessment
  • Coronary dominance determination
  • Bifurcation angle measurements for complex lesions

Intravascular Ultrasound (IVUS) Analysis

• Provides cross-sectional images of vessel walls 2
• Analysis should focus on:
  • Plaque burden quantification
  • Vessel remodeling assessment
  • Calcium distribution and extent
  • Minimum lumen area measurements
  • Stent apposition and expansion evaluation

Optical Coherence Tomography (OCT) Analysis

• Highest resolution (10-20μm axial) among intravascular imaging modalities 2
• Analysis includes:
  • Detailed plaque characterization (fibrous, lipid-rich, calcified)
  • Thin-cap fibroatheroma identification
  • Thrombus detection and characterization
  • Precise stent strut coverage assessment
  • Dissection and tissue protrusion evaluation

Cerebrovascular Angiography Analysis

• Critical for assessment of intracranial aneurysms 2
• Analysis should include:
  • Aneurysm morphology (saccular vs. fusiform)
  • Neck-to-dome ratio measurements
  • Parent vessel relationship
  • Branch vessels arising from aneurysm
  • Flow dynamics and hemodynamic stress points

Quantitative Analysis Methods

• Automated vessel edge detection algorithms
• Stenosis quantification using reference vessel measurements
• Frame counting for flow assessment
• Densitometric analysis of contrast opacification
• Artificial intelligence-based plaque characterization 2

Common Pitfalls in Angiogram Analysis

• Underestimating stenosis severity due to diffuse disease 2
• Misinterpreting overlapping vessels as stenosis
• Failing to recognize eccentric lesions that may appear mild in certain projections
• Not accounting for vessel foreshortening in measurements
• Mistaking angiogram (the image) for angiography (the procedure) 1
• Assuming all angiography methods provide equivalent information 1

Educational Applications of Angiogram Videos

• Patient education videos about angiography procedures have been shown to:
  • Improve patient knowledge and understanding 3, 4
  • Reduce pre-procedural anxiety 3
  • Increase patient satisfaction 4
  • Lead to better clinical outcomes 5

Integration with Other Imaging Modalities

• Correlation with non-invasive imaging (CT, MRI, ultrasound)
• Fusion imaging techniques combining angiography with other modalities
• Use of intraoperative tools like indocyanine green video angiography during surgical clipping of aneurysms 2
• Video angioscopy as an alternative to intraoperative arteriography in some vascular procedures 6

Future Directions

• Artificial intelligence and machine learning algorithms for automated analysis
• Integration of computational fluid dynamics for hemodynamic assessment
• Augmented reality applications for procedural guidance
• Optical coherence tomography angiography (OCTA) as a non-invasive alternative to fluorescein angiography in retinal imaging 2

Angiogram video analysis requires specialized training and expertise to properly interpret the complex vascular findings and translate them into clinically meaningful information that can guide appropriate therapeutic interventions.