Enhanced stent imaging improves the diagnosis of stent underexpansion and optimizes stent deployment

Authors

  • Elias A. Sanidas MD,

    1. New York-Presbyterian Hospital, Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York
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  • Akiko Maehara MD,

    1. New York-Presbyterian Hospital, Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York
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  • Ravit Barkama MD,

    1. New York-Presbyterian Hospital, Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York
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  • Gary S. Mintz MD,

    1. New York-Presbyterian Hospital, Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York
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  • Varinder Singh MD,

    1. New York-Presbyterian Hospital, Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York
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  • Ariel Hidalgo MD,

    1. New York-Presbyterian Hospital, Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York
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  • Diaa Hakim MD, PhD,

    1. New York-Presbyterian Hospital, Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York
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  • Martin B. Leon MD,

    1. New York-Presbyterian Hospital, Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York
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  • Jeffrey W. Moses MD,

    1. New York-Presbyterian Hospital, Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York
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  • Giora Weisz MD

    Corresponding author
    • New York-Presbyterian Hospital, Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York
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  • Conflict of interest: Dr. Barkama was a prior employee of Paieon (until June 2008), but currently has no other potential conflict of interest with the sponsor. Dr. Maehara has received research/grant support from Volcano Corporation and Boston Scientific Corporation. Dr. Mintz is consultant for Volcano Corporation and Boston Scientific Corporation and has received grant/fellowship support from both Volcano Corporation and Boston Scientific Corporation. Dr. Leon is member of the advisory boards for Boston Scientific Corporation.

Correspondence to: Giora Weisz, MD, Columbia University, Center for Interventional Vascular Therapy, Columbia University Medical Center, 161 Fort Washington Ave., 5th Floor, New York, NY 10032. E-mail: gw2128@columbia.edu

Abstract

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 = 0.721, P < 0.0001) than did QCA with IVUS (r = 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 = 0.038 vs. 0.121; P = 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. © 2012 Wiley Periodicals, Inc.

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