Stig Radner

An attempt at the roentgenologic visualization of coronary blood vessels in man.

Visceral angiography was first introduced to medical science through the publication of EGAS MONIZ, in 1927, when he described a method of visualizing the blood vessels of the brain. Since then, the same principles of examination have been applied to an ever-increasing number of the deep blood vessels. The aorta abdominalis and its branches to the abdominal organs were made opaque to roentgen rays by DOS SANTOS, LAMAS & CALDAS in 1929. Two years later, EGAS MONIZ, DE CARVALHO & LIMA introduced arteriographic examination of the pulmonary blood vessels by Forssman’s technique, and in 1936 NUVOLI opacified the aorta thoracalis. Finally, in 1938, CASTELLANOS, PEREIRAS & GARCIA, and ROBB & STEINBERG succeeded in outlining all the chambers of the heart and the great central vessels. The major part of the human circulatory system has thus been made available for intravital exploration. There still exists, however, an important part of the visceral vascular system which lies outside the scope of the angiographic technique, namely, the coronary blood vessels. These vessels have already been the subject of roentgenographic study in the living subject. Thus, in coronary sclerosis, mural calcareous deposits, in some instances combined with regional pathologic changes in the outline of the myocardium, have been described (R. LENK, 1927). While precipitation of calcium can occur in atheromatous coronary arteries with unimpaired function, a secondary circumscribed change in the contour of the heart and the amplitude of contractions, in coronary thrombosis, seems to be of more significance from the diagnostic point of view (LEVENE & REID, 1932). Provided the intervention could be done without undue risk for the patient the visualizing of these vessels would serve as a further aid in the roentgen diagnosis of diseases of the coronary vessels. It is obvious that direct puncturing of coronary arteries is a serious intervention involving risk for the patient’s life, and it should therefore not be done merely in the interests of diagnosis. A more suitable measure seems to be to place the radiopaque substance, after puncturing, in the blood cistern from which these arteries are fed, in other words, in the bulb of the aorta. Working on the basis of this reasoning, P. ROUSTHÖI in 1933 was able to demonstrate that opacification starting from the ascending aorta was possible in different animals. (See fig. 1.) Having confirmed, in the dog, the observations of ROUSTHÖI the next step of the present author was to apply the experiences gained with animals to man. In this connection, a number of technical problems arose, most of which were finally overcome. As far as the technique of injection is concerned, it was already known that NUVOLI had punctured the ascending aorta through the sternum without complications. AS NUVOLI’S paper was only available in the form of a short review the details of his method are not known. His object was to study an aneurysm on the aortic arch by arteriography, and there is thus reason to presume that he endeavoured to visualize this segment of the aorta in particular. The method I employed was briefly the following.

SUPRAVITAL ANALYSIS OF DISORDERS IN THE CEREBROVASCULAR PERMEABILITY

Disorders in the permeability of the cerebral vessels are probably an important pathogenetic factor in various diseases and pathological conditions. The ordinary anatomico-pathological examination of a brain does not disclose direct evidence of such a disturbance, but several morphological criteria may be produced in certain cases for such an assumption, e.g. a maximal distension and engorgement of the smaller veins and capillaries, signs of stasis, degenerative changes or complete necrosis of the vessel wall, distension of the perivascular spaces, often with serous fluid, petechial hemorrhages, and perivascular necrosis of the brain tissue. Scheinker recently described a number of pathological conditions displaying this histopathological picture and designated them “vasoparalysis” (1944, 1945, 1945). The ordinary technique applied to experimental animals to show the existence of a disturbance in the vascular permeability of the brain, cannot of course be employed agonally in man. When animal experiments revealed that, as far as special dye-stuffs are concerned, the cerebral vessels keep their permeability unchanged a short time post inortern, the way was open for experimental studies of human brains (Broman, 1938, 19-10). Such examinations were made and with positive results (Brornan, 1944, 1947). For example, a distinctly discernible passage of the dyes through the vascular walls into the cerebral tissue was demonstrated in different kinds of brain tumours, in regions of cerebral edema, in the plaques of multiple sclerosis, and perifocally around massive hemorrhages and softenings. The present investigation constitutes a continuation of the above studies. Earlier experience showed that the method is impaired by a number of considerable sources of error, and that several findings could not

THE DURATION OF EXPERIMENTAL DISTURBANCES IN THE CEREBRO-VASCULAR PERMEABILITY DUE TO CIRCUMSCRIBED GROSS DAMAGE OF THE BRAIN

In earlier investigations colour indicators have shown that disorders in the cerebrovascular permeability are relatively brief. Broman (1940) , for example, showed that such a disorder was observable in the pial vessels only for about one hour after a 10-20 minute passage of air or fat emboli. With solid micro-embolism which become lodged in the vessels the disorder in the permeability localized in the immediate vicinity of the emboli lasted about five days (probably longer in cases with fat emboli in which the latter could be displaced later, e . g . by raising the blood pressure). Toxic lesions of the vascular wall such as the suspected allergic lesion produced experimentally in the brains of guinea-pigs by sheep hemolytic rabbit serum (Forssman, 1922, 1926; Skoog, 1937) lasted up to seven hours. (Broman k Lindberg-Broman, 1945). Another type of toxic vascular lesion produced by a certain contrast medium for cerebral angiograyhy (Umbradil for te) , was of an especially mild nature and disappeared already after one to two hours (Broman’ & OISSOR, 1948). The disseminated cerebrovascular disorder produced in insulin coma and metrazol shock ceased practically immediately aften the coma and the shock, respectively, had worn off (Rjerner, Broman & Swensson, 1944). In experiments with a disturbance of the cerebrovascular permeability due to local traumatization