Clinical applications of a new enhanced stent imaging technology (original) (raw)
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Enhanced stent imaging improves the diagnosis of stent underexpansion and optimizes stent deployment
Catheterization and Cardiovascular Interventions, 2012
Objectives: To investigate the clinical value and diagnostic accuracy of enhanced stent imaging (ESI) as compared with quantitative coronary angiography (QCA) and intravascular ultrasound (IVUS). Background: ESI is an image acquisition and processing angiography-based software that improves visualization and provides measurements of deployed stents. Methods: A total of 40 consecutive patients (42 stents) were studied. Stent deployment was evaluated sequentially and independently by angiography, ESI, and IVUS. Following each imaging modality, the operator determined the necessity of postdilation unrelated to the other modalities. Stent diameters were measured off-line by QCA, ESI, and IVUS at several sites along the deployed stent and compared. Results: Following stent deployment and based solely on angiography, the operator decided to postdilate seven of the 42 stents (16.7%). This decision was not changed after reviewing the ESI images of these seven stents. Of the 35 stents not requiring postdilation based on angiography alone, ESI influenced the operator to change the decision and postdilate 10 of 35 stents (28.6%). The ESI-based measurements had better correlation with IVUS (r 5 0.721, P < 0.0001) than did QCA with IVUS (r 5 0.563, P < 0.0001). Bland-Altman analysis showed a trend towards better agreement between ESI and IVUS than between QCA and IVUS (mean differences 5 0.038 vs. 0.121; P 5 0.19, respectively). Conclusions: ESI is an easy to use modality that enhances stent visualization, helps in the decision making process whether to postdilate the stent, and provides estimation of stent expansion with better correlations than QCA when compared to IVUS.
Circulation Journal, 2016
a different approach, performing a prospective analysis of consecutive patients with SF-predisposing factors treated with a 2nd-generation DES, with the aim of: (1) testing the value of an enhanced stent visualization (ESV) system in SF detection during the index PCI and (2) identifying patients at high risk for adverse events during follow-up. Methods Study Population In our center, clinical and procedural data from all patients undergoing PCI for ischemic heart disease are recorded and patients are prospectively followed up for at least 12 months. 7-9 According to our institutional protocol, 8,10,11 we systematically perform an ESV system evaluation after stent implantation in patients undergoing PCI. The present analysis was performed in those patients with both SFpredisposing factors 1-5 and available ESV images from during their index procedure (Figure 1). Predisposing factors for SF were: (1) overlapping stents, (2) vessel tortuosity (defined as ≥2 bends of ≥75°, 1 bend ≥90° or significant
Journal of Cardiovascular Intervention
Background: Complex percutaneous coronary intervention (PCI) procedures involving overlapping stents or bifurcation stenting require a lot of fluoroscopic time, which leads to high X-ray exposure for the patient as well as the medical staff. ClearStent Live is a real-time enhanced stent visualization (ESV) tool enabling a stabilized display in real time and improved visualization of stents during PCIs. It also allows a high-quality, real-time evaluation of overlapping stent deployment and assessment of integrity, apposition as well as distortion of the stent. This study is to compare the cumulative radiation dose (dose area product; DAP) in coronary stenting of coronary lesions performed with or without ClearStent Live in PCI. Methods: This is a prospective, open-label, non-randomized study with 100 patients. The treatment group comprises 50 patients who underwent stenting supported by ClearStent Live, as compared to the control group without ClearStent Live support (with standard fluoroscopic, cineangiography imaging or ClearStent). Results: The DAP in the ClearStent Live group was significantly lower than in the group without ClearStent Live (5,290.83 ± 2,367.07 μGym 2 vs. 6,499.28 ± 3,140.12 μGym 2 , P = 0.03). The volume of contrast used was also significantly lower in the ClearStent Live group when compared to the non-ClearStent Live group (111.80 ± 15.86 mL vs. 128.60 ± 25.72 mL, P < 0.01). Conclusions: The study shows that PCIs for patients with 2 or more overlapping stents required less radiation dosage and volume of contrast agent when ClearStent Live was used when compared to PCIs without ClearStent Live which encourages the routine use of realtime ESV tools in overlapping stent procedures.
Use of Stent Enhancement Technique During Percutaneous Coronary Intervention – A Case Series
Heart International
tent enhancement allows clear visualisation of implanted stents. This method, originally intended to assess stent under-expansion, can prove extremely valuable in several other situations. We present three cases illustrating its potential uses in assessment of stent failure, intraprocedural stent disruption, and treatment of aorto-ostial and bifurcation lesions. Whilst stent enhancement cannot replace intravascular imaging, compared to simple angiography it can significantly improve percutaneous coronary intervention outcomes with no additional cost and with minimal procedural time.
Ultrasound in Medicine & Biology, 1998
Three-dimensional (3D) intracoronary ultrasound (ICUS) systems allow dynamic 3D reconstruction of coronary segments after stent deployment, but motion artifacts are frequently present. The use of an electrocardiographic-gated ICUS image acquisition workstation and a dedicated pullback device may overcome this problem. In the present study, we evaluated the potential of dynamic 3D reconstruction of intracoronary stents in 51 patients. Two different types of stent designs were investigated: (1) the Wallstent (mesh type; n ؍ 36) and (2) the Cordis Coronary stent (coil type; n ؍ 15). There was a tendency for imaging of the mesh stent type to be better than imaging of coil type stents (p ؍ 0.06). Differences in the orientation of the stent struts (mesh:longitudinal; coil:transversal) most likely explain this difference. These in vivo observations were tested and confirmed in in vitro experiments. In conclusion, dynamic 3D ICUS reconstruction of the entire stent architecture in vivo was feasible for stents of mesh type, while stents of coil type were incompletely visualized.