1
|
Mansour HM, Mohamed AM, Ibrahim SG, Ibrahim AM, Mohamed RG. Value of stent boost imaging in decision making after coronary stenting. Int J Cardiovasc Imaging 2023; 39:2557-2566. [PMID: 37845408 PMCID: PMC10692007 DOI: 10.1007/s10554-023-02961-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/16/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Several studies reported the comparability of digital stent enhancement techniques (including stent boost imaging) in detecting suboptimal results of coronary stenting with Intra Vascular Ultrasound and optical coherence tomography. AIMS to assess results of stent deployment and determine the incidence of suboptimal results requiring changing final decision using stent boost imaging. METHODS This cross-sectional study included 120 patients eligible for PCI were recruited during a period of one year (January 2021 to 2022) using DES. RESULTS Suboptimal results were found in 38% of the PCI cases with stents (angiography guided). Importantly it was found that improper lesion preparation in our practice could not help improving stent optimization. Also, angiography guided PCI has significant incidence of suboptimal results. Digital stent enhancement techniques like stent boost have significant and important value in better decision making. After adjusting for age and sex, six factors were identified as independent predictors for final decision change (stent length, LAD/RCA affection, proximal segment affection, calcification, and optical coherence tomography. CONCLUSION This study has confirmed the utility of stent boost for the optimization of PCI in daily practice. Stent Boost is a simple and costless technique that provides an accurate assessment of a deployed stent without extending the procedure time and without more risk. It appears to be useful for the immediate evaluation of stent expansion and optimization of PCI by additional post-dilatation, when appropriate. Future studies are needed to determine whether Stent Boost data will correlate with adverse long-term clinical outcomes in patients undergoing PCI.
Collapse
Affiliation(s)
- Hossam M Mansour
- Department of Cardiology, Faculty of Medicine, Aswan University, Aswan, 81528, Egypt
| | - Ahmed M Mohamed
- Department of Cardiology, Faculty of Medicine, Aswan University, Aswan, 81528, Egypt.
| | - Soliman G Ibrahim
- Department of Cardiology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ayman M Ibrahim
- Department of Cardiology, Faculty of Medicine, Aswan University, Aswan, 81528, Egypt
| | - Ramadan G Mohamed
- Department of Cardiology, Faculty of Medicine, Aswan University, Aswan, 81528, Egypt
| |
Collapse
|
2
|
Yao QY, Fu ML, Zhao Q, Zheng XM, Tang K, Cao LM. Image-based visualization of stents in mechanical thrombectomy for acute ischemic stroke: Preliminary findings from a series of cases. World J Clin Cases 2023; 11:5047-5055. [PMID: 37583850 PMCID: PMC10424012 DOI: 10.12998/wjcc.v11.i21.5047] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/17/2023] [Accepted: 07/04/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Mechanical thrombectomy is the most effective treatment for great cerebral artery embolization within a set time window. Typically, an arteriogram does not show the localization of the stent after release and whether a thrombus is captured or not. Thus, improving the visualization of a stent in interventional therapy will be helpful for clinicians. AIM To analyze stent imaging findings to enhance clinicians' understanding of a special circumstance, wherein a Solitaire AB retrievable stent was visible during the imaging of a thrombus capture that improved the success rate of stent-based mechanical thrombectomy. METHODS This was a retrospective study with four acute ischemic stroke (AIS) patients who underwent stent-based mechanical thrombectomy. RESULTS Patient 1 was a 64-year-old man admitted after 5 h of confusion; angiography revealed basilar artery occlusion. We inserted a stent into the left posterior cerebral artery-P2 segment and visualized the expanded stent that successfully captured a thrombus. Patient 2 was a 74-year-old man admitted with confusion, which lasted approximately 3 h. Angiography revealed a left middle cerebral artery (MCA)-M1 segment occlusion. A stent was deployed in the distal M2 segment, and we could visualize the stent by capturing the thrombus. Patient 3 was a 74-year-old woman admitted after experiencing left hemiplegia for 3 h. We deployed a stent at the distal right MCA-M2 segment, and the developing stent captured a large thrombus. Patient 4 was an 82-year-old man who presented with confusion for 3 h. A developing stent was placed in the distal left MCA-M1 segment, which captured a large thrombus and several fragmented thrombi. CONCLUSION To the best of our knowledge, this is the first report of stent imaging in patients with AIS. We demonstrated the usefulness and substantial potential of stent imaging in stent-based mechanical thrombectomy for AIS.
Collapse
Affiliation(s)
- Qing-Yang Yao
- Department of Neurology, The First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Mao-Lin Fu
- Department of Neurology, The 910th Hospital of the Joint Logistics Support Force of the Chinese PLA, Quanzhou 362000, Fujian Province, China
| | - Qing Zhao
- Department of Neurology, The 910th Hospital of the Joint Logistics Support Force of the Chinese PLA, Quanzhou 362000, Fujian Province, China
| | - Xiao-Ming Zheng
- Department of Neurology, The 910th Hospital of the Joint Logistics Support Force of the Chinese PLA, Quanzhou 362000, Fujian Province, China
| | - Kai Tang
- Department of Neurology, The 910th Hospital of the Joint Logistics Support Force of the Chinese PLA, Quanzhou 362000, Fujian Province, China
| | - Li-Ming Cao
- Department of Neurology, The First Affiliated Hospital of Shenzhen University, Shenzhen 518000, Guangdong Province, China
- Hunan Provincial Key Laboratory of The Research and Development of Novel Pharmaceutical Preparations, Changsha Medical University, Changsha 410219, Hunan Province, China
| |
Collapse
|
3
|
Optical coherence tomography: evaluating the effects of stent boost subtract imaging on stent underexpansion in STEMI patients. BMC Cardiovasc Disord 2022; 22:62. [PMID: 35184740 PMCID: PMC8859886 DOI: 10.1186/s12872-022-02498-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 01/31/2022] [Indexed: 11/23/2022] Open
Abstract
Background To evaluate the effect of stent boost subtract (SBS) imaging on stent underexpansion during percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI) by optical coherence tomography (OCT). Methods One hundred thirty-eight STEMI patients who underwent drug-eluting stent (DES) implantation were prospectively recruited and divided into the SBS group (69 cases) and the CAG group (69 cases) according to whether SBS was used to guide PCI. Finally, OCT was performed on all enrolled patients, and the OCT results were used as the gold standard to evaluate the impact of standard SBS technology on stent underexpansion immediately after DES implantation. Results SBS identified 51 patients (24%) with stent underexpansion while OCT identified 56 patients (27.2%). SBS has a sensitivity of 80%, a specificity of 96%, a positive predictive value of 88%, and a negative predictive value of 93% for identifying stent underexpansion. Conclusion Compared with OCT, SBS technology is a rapid stent imaging evaluation method that can accurately quantify the stent expansion level and is time-saving and economical. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02498-9.
Collapse
|
4
|
Ghafari C, Carlier S. Stent visualization methods to guide percutaneous coronary interventions and assess long-term patency. World J Cardiol 2021; 13:416-437. [PMID: 34621487 PMCID: PMC8462039 DOI: 10.4330/wjc.v13.i9.416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/24/2021] [Accepted: 07/22/2021] [Indexed: 02/06/2023] Open
Abstract
Evaluation of acute percutaneous coronary intervention (PCI) results and long-term follow-up remains challenging with ongoing stent designs. Several imaging tools have been developed to assess native vessel atherosclerosis and stent expansion, improving overall PCI results and reducing adverse cardiac events. Quantitative coronary analysis has played a crucial role in quantifying the extent of coronary artery disease and stent results. Digital stent enhancement methods have been well validated and improved stent strut visualization. Intravascular imaging remains the gold standard in PCI guidance but adds costs and time to the procedure. With a recent shift towards non-invasive imaging assessment and coronary computed tomography angiography imaging have shown promising results. We hereby review novel stent visualization techniques used to guide PCI and assess stent patency in the modern PCI era.
Collapse
Affiliation(s)
| | - Stéphane Carlier
- Department of Cardiology, UMONS, Mons 7000, Belgium
- Department of Cardiology, CHU Ambroise Paré, Mons 7000, Belgium
| |
Collapse
|
5
|
McBeath KCC, Rathod KS, Cadd M, Beirne A, Guttmann O, Knight CJ, Amersey R, Bourantas CV, Wragg A, Smith EJ, Baumbach A, Mathur A, Jones DA. Use of enhanced stent visualisation compared to angiography alone to guide percutaneous coronary intervention. Int J Cardiol 2020; 321:24-29. [PMID: 32800911 DOI: 10.1016/j.ijcard.2020.08.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/01/2020] [Accepted: 08/07/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE We aimed to assess the use of enhanced stent visualisation (ESV) on outcomes, after PCI with overlapping stents, specifically using CLEARstent technology. BACKGROUND Stent underexpansion and overlap are both significant risk factors for restenosis and stent thrombosis. Enhanced stent visualisation (e.g. CLEARstent) systems could provide important data to reduce under-expansion and stent overlap. METHODS This was a cohort study based on this institution's percutaneous coronary intervention (PCI) registry. A total of 2614 patients who had PCI for stable angina or acute coronary syndromes (ACS, excluding cardiogenic shock) with overlapping 2nd generation drug eluting stents (DES) in the same vessel between May 2015 and January 2018 were included in the analysis. Patients were divided into ESV (n = 1354) and no ESV guided intervention (n = 1260). The primary end-point was major adverse cardiovascular events (MACE: target vessel revascularisation, target vessel myocardial infarction and all-cause mortality) recorded at a median follow up of 2.4 years. RESULTS Groups were comparable for patient characteristics (age, diabetes mellitus, ACS presentation). A significant difference in MACE was observed between patients who underwent ESV-guided PCI (9.5%) compared with patients who underwent Standard PCI (14.4%, p = .018). This difference was mainly driven by reduced rates of target vessel revascularisation and recurrent myocardial infarction. Overall this difference persisted after multivariate Cox analysis (HR 0.86, 95% CI: 0.73-0.98) and propensity matching (HR = 0.88, 95% CI: 0.69-0.99). CONCLUSION We suggest that routine clinical use of ESV technology during PCI can be useful, and is associated with better medium-term angiographic and clinical outcomes. Further study is required to build on this promising signal.
Collapse
Affiliation(s)
- K C C McBeath
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, United Kingdom
| | - K S Rathod
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, United Kingdom
| | - M Cadd
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, United Kingdom
| | - A Beirne
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, United Kingdom
| | - O Guttmann
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, United Kingdom
| | - C J Knight
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, United Kingdom
| | - R Amersey
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, United Kingdom
| | - C V Bourantas
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, United Kingdom
| | - A Wragg
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, United Kingdom
| | - E J Smith
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, United Kingdom
| | - A Baumbach
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, United Kingdom
| | - A Mathur
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, United Kingdom
| | - D A Jones
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London EC1A 7BE, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, United Kingdom.
| |
Collapse
|
6
|
Chen Q, Zhang LW, Huang DS, Zhang CH, Wang QS, Shen D, Xiong MJ, Yang FF. Five-year Clinical Outcomes of CAD Patients Complicated with Diabetes after StentBoost-optimized Percutaneous Coronary Intervention. ACTA ACUST UNITED AC 2020; 34:177-183. [PMID: 31601300 DOI: 10.24920/003496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective To evaluate the instant effects and five-year clinical outcomes of coronary artery disease patients complicated with diabetes mellitus after StentBoost-optimized percutaneous coronary intervention (PCI). Methods From March 2009 to July 2010, 184 patients undergoing PCI at our hospital were found stent underexpansion or malapposition by StentBoost after stents implantation and were divided into the diabetic (n=73, 39.67%) and the non-diabetic group (n=111, 60.33%). All patients received StentBoost-guided post-dilatation after stent implantation. The instant procedural results were measured and clinical outcome after five-year follow-up was analyzed in each group. Between-group comparisons were performed using Chi-square test or Student's t test. Multivariate logistic regression analysis was carried out to reveal the independent predictors for long-term clinical outcomes of StentBoost-optimized PCI . Results After StentBoost-guided post-dilatation, the minimum diameter (MinLD), maximum diameter (MaxLD) and average diameter in both groups increased significantly than before (P<0.001), the (MaxLD-MinLD)/MaxLD ratio and the in-stent residual stenosis decreased accordingly (P<0.001). The five-year follow-up showed similar mortality rate (4.92% vs. 2.86%, P=0.67) and major adverse cardiac event rate (11.48% vs. 11.43%, P = 1.0) between the diabetic and the non-diabetic group, whereas the recurrence of angina pectoris was higher in the diabetic group compared to the non-diabetic group (47.54% vs. 29.52%; P=0.02). A multivariate logistic regression analysis revealed that age and left ventricular ejection fraction rather than diabetes mellitus were independent predictors for long-term clinical outcomes. Conclusions StentBoost could effectively improve instant PCI results; the long-term clinical outcomes of StentBoost-optimized PCI were similar between diabetic and non-diabetic patients. Age and left ventricular ejection fraction were the independent predictors for long-term clinical outcomes.
Collapse
Affiliation(s)
- Qiang Chen
- Department of Cardiology, The Fourth Medical Center of Chinese PLA General Hospital, Beijing 100048, China
| | - Li-Wei Zhang
- Department of Cardiology, The Fourth Medical Center of Chinese PLA General Hospital, Beijing 100048, China
| | - Dang-Sheng Huang
- Department of Cardiology, The Fourth Medical Center of Chinese PLA General Hospital, Beijing 100048, China
| | - Chun-Hong Zhang
- Department of Cardiology, The Fourth Medical Center of Chinese PLA General Hospital, Beijing 100048, China
| | - Qiu-Shuang Wang
- Department of Cardiology, The Fourth Medical Center of Chinese PLA General Hospital, Beijing 100048, China
| | - Dong Shen
- Department of Cardiology, The Fourth Medical Center of Chinese PLA General Hospital, Beijing 100048, China
| | - Min-Jun Xiong
- Department of Cardiology, The Fourth Medical Center of Chinese PLA General Hospital, Beijing 100048, China
| | - Fei-Fei Yang
- Department of Cardiology, The Fourth Medical Center of Chinese PLA General Hospital, Beijing 100048, China
| |
Collapse
|
7
|
Figini F, Louvard Y, Sheiban I. Use of Stent Enhancement Technique During Percutaneous Coronary Intervention - A Case Series. Heart Int 2019; 13:28-31. [PMID: 36275501 PMCID: PMC9524748 DOI: 10.17925/hi.2019.13.1.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 05/21/2019] [Indexed: 09/06/2024] Open
Abstract
Stent 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.
Collapse
Affiliation(s)
- Filippo Figini
- Interventional Cardiology, Ospedale “Pederzoli”, Peschiera del Garda, Verona, Italy
| | - Yves Louvard
- Interventional Cardiology, Institut Cardiovasculaire Paris Sud, Massy, France
| | - Imad Sheiban
- Interventional Cardiology, Ospedale “Pederzoli”, Peschiera del Garda, Verona, Italy
| |
Collapse
|
8
|
Figini F, Louvard Y, Sheiban I. Stent Enhancement during Percutaneous Coronary Intervention: Current Role, Technical Tips and Case Examples. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:137-143. [PMID: 31213367 DOI: 10.1016/j.carrev.2019.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 03/31/2019] [Accepted: 04/01/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Filippo Figini
- Interventional Cardiology, Ospedale "Pederzoli", Peschiera del Garda, VR, Italy
| | - Yves Louvard
- Interventional Cardiology, Institut Cardiovasculaire Paris Sud, Massy, France
| | - Imad Sheiban
- Interventional Cardiology, Ospedale "Pederzoli", Peschiera del Garda, VR, Italy.
| |
Collapse
|
9
|
Laimoud M, Nassar Y, Omar W, Abdelbarry A, Elghawaby H. Stent boost enhancement compared to intravascular ultrasound in the evaluation of stent expansion in elective percutaneous coronary interventions. Egypt Heart J 2017; 70:21-26. [PMID: 29622993 PMCID: PMC5883512 DOI: 10.1016/j.ehj.2017.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 09/26/2017] [Indexed: 12/16/2022] Open
Abstract
Background Stent underexpansion is a major risk factor for in-stent restenosis and acute in-stent thrombosis1Intravascular ultrasound (IVUS) is one of the standards for detection of stent underexpansion (de Feyter et al. 1999; Mintz et al., 2001). StentBoost (SB) enhancement allows an improved angiographic visualization of the stent (Koolen et al., 2005). Aim of work Comparison of stent expansion by IVUS and SB enhancement and detection of value of SB to guide dilatation post stent deployment. Methodology IVUS, SB enhancement and QCA were done in 30 patients admitted for elective stenting procedures .We compared measurements of mean ±standard deviations of (Max SD, Min SD, Mean SD, stent symmetry index) using IVUS, SB and QCA after stent deployment and after postdilatation whenever necessary to optimize stent deployment. The Stent symmetry index was calculated [(maximum stent diameter minus minimum stent diameter) divided by maximum stent diameter]. Results The Max SD was (3.45 ± 0.62 vs 3.55 ± 0.56 vs 2.97 ± 0.59) by IVUS vs SB vs QCA respectively. Max SD was significantly higher by IVUS vs QCA (p .009) and between SB vs QCA (p .001) while there was nonsignificant difference between IVUS vs SB (p .53). The Min SD was (2.77 ± 0.53 vs 2.58 ± 0.56 vs 1.88 ± 0.60) by IVUS vs SB vs QCA respectively. Min SD was significantly higher by IVUS vs QCA (p .001) and between SB vs QCA (p .001) while there was nonsignificant difference between IVUS vs SB (p .07). The stent symmetry index was (0.24 ±0.09 vs 0.34 ± 0.09 vs 0.14 ±0.27) by IVUS vs SB vs QCA respectively. It was significantly higher by IVUS vs QCA (p .001) and between SB vs QCA (p .001) while there was nonsignificant difference between IVUS vs SB (p .32). SB was positively correlated with IVUS measurements of Max SD (p < .0001 & r 0.74) and Min SD (p < .0001 & r 0.68). QCA was positively correlated with IVUS measurements of Max SD correlation (p < .0001 & r 0.69) and Min SD (p < .0001 & r 0.63). QCA was positively correlated with SB measurements of Max SD (p < .0001 & r 0.61) and Min SD (p .003 & r 0.49). Conclusions StentBoost enhancement has superior correlations for stent expansion measured by IVUS when compared with QCA. SB enhancement improved stent visualization and identification of stent underexpansion to guide stent postdilatation.
Collapse
Affiliation(s)
| | - Yasser Nassar
- Critical Care Medicine Department-Cairo University, Egypt
| | - Walid Omar
- Critical Care Medicine Department-Cairo University, Egypt
| | | | | |
Collapse
|
10
|
|
11
|
Silva MA, See AP, Dasenbrock HH, Ashour R, Khandelwal P, Patel NJ, Frerichs KU, Aziz-Sultan MA. Stent deployment protocol for optimized real-time visualization during endovascular neurosurgery. J Neurosurg 2016; 126:1614-1621. [PMID: 27341046 DOI: 10.3171/2016.4.jns16194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Successful application of endovascular neurosurgery depends on high-quality imaging to define the pathology and the devices as they are being deployed. This is especially challenging in the treatment of complex cases, particularly in proximity to the skull base or in patients who have undergone prior endovascular treatment. The authors sought to optimize real-time image guidance using a simple algorithm that can be applied to any existing fluoroscopy system. Exposure management (exposure level, pulse management) and image post-processing parameters (edge enhancement) were modified from traditional fluoroscopy to improve visualization of device position and material density during deployment. Examples include the deployment of coils in small aneurysms, coils in giant aneurysms, the Pipeline embolization device (PED), the Woven EndoBridge (WEB) device, and carotid artery stents. The authors report on the development of the protocol and their experience using representative cases. The stent deployment protocol is an image capture and post-processing algorithm that can be applied to existing fluoroscopy systems to improve real-time visualization of device deployment without hardware modifications. Improved image guidance facilitates aneurysm coil packing and proper positioning and deployment of carotid artery stents, flow diverters, and the WEB device, especially in the context of complex anatomy and an obscured field of view.
Collapse
Affiliation(s)
- Michael A Silva
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alfred P See
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Hormuzdiyar H Dasenbrock
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ramsey Ashour
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Priyank Khandelwal
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nirav J Patel
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kai U Frerichs
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mohammad A Aziz-Sultan
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
12
|
Kabbasch C, Mpotsaris A, Chang DH, Hiß S, Dorn F, Behme D, Onur O, Liebig T. Mechanical thrombectomy with the Trevo ProVue device in ischemic stroke patients: does improved visibility translate into a clinical benefit? J Neurointerv Surg 2015; 8:778-82. [PMID: 26276075 DOI: 10.1136/neurintsurg-2015-011861] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 07/22/2015] [Indexed: 11/04/2022]
Abstract
PURPOSE To investigate the efficacy and safety of the Trevo ProVue (TPV) stent retriever in stroke patients with large artery occlusions, with particular attention to the full structural radiopacity of the TPV. MATERIALS AND METHODS Case files and images of TPV treatments were reviewed for clinical and technical outcome data, including revascularization rates, device and procedure related complications, and outcome at discharge and after 90 days. RESULTS 76 patients were treated with TPV. Mean National Institutes of Health Stroke Scale (NIHSS) score was 18 and 68% had additional intravenous thrombolysis. 63 occlusions were in the anterior circulation: 44 M1 (58%), 8 M2 (11%), 8 internal carotid artery-terminus (11%), 2 internal carotid artery- left (3%), 1 A2 (1%), and 13 vertebrobasilar (17%). 58 of 76 (76%) were solely treated with TPV; the remainder were treated with additional stent retrievers. Mean number of passes in TPV only cases was 2.2 (SD 1.2). In rescue cases, 3.2 (SD 2.2) passes were attempted with the TPV followed by 2.6 rescue device passes (SD 2). TPV related adverse events occurred in 4/76 cases (5%) and procedural events in 6/76 cases (8%). Mean procedural duration was 64 min (SD 42). Thrombolysis in Cerebral Infarction (TICI) 2b/3 recanalization was achieved in 69/76 patients (91%), including 50% TICI 3. Of 56 survivors (74%), 37 (49%) showed a favorable outcome at 90 days (Solitaire With the Intention for Thrombectomy trial criteria), statistically associated with age, baseline NIHSS, onset to revascularization time, and TICI 2b-3 reperfusion. TPV radiopacity allowed for visual feedback, changing the methodology of stent retriever use in 44/76 cases (58%). CONCLUSIONS Neurothrombectomy with TPV is feasible, effective, and safe. The recanalization rate compares favorably with reported data in the literature. Improved structural radiopacity may facilitate neurothrombectomy or influence the course of action during retrieval.
Collapse
Affiliation(s)
- Christoph Kabbasch
- Department of Radiology and Neuroradiology, University Hospital of Cologne, Cologne, Germany
| | - Anastasios Mpotsaris
- Department of Radiology and Neuroradiology, University Hospital of Cologne, Cologne, Germany
| | - De-Hua Chang
- Department of Radiology and Neuroradiology, University Hospital of Cologne, Cologne, Germany
| | - Sonja Hiß
- Department of Radiology and Neuroradiology, University Hospital of Cologne, Cologne, Germany
| | - Franziska Dorn
- Department of Radiology and Neuroradiology, University Hospital of Cologne, Cologne, Germany
| | - Daniel Behme
- Department of Neuroradiology, University Medical Center Goettingen, Goettingen, Germany
| | - Oezguer Onur
- Department of Neurology, University Hospital of Cologne, Cologne, Germany
| | - Thomas Liebig
- Department of Radiology and Neuroradiology, University Hospital of Cologne, Cologne, Germany
| |
Collapse
|