[en] Background: Stent underexpansion is the main cause of stent thrombosis and restenosis. Coronary angiography has limitations in the assessment of stent expansion. Enhanced stent imaging (ESI) methods allow a detailed visualization of stent deployment. We qualitatively compare image results from two ESI system vendors (StentBoost™ (SB) and CAAS StentEnhancer™ (SE)) and report quantitative results of deployed stents diameters by quantitative coronary angiography (QCA) and by SE. (2) Methods: The ESI systems from SB and SE were compared and graded by two blinded observers for different characteristics: 1 visualization of the proximal and distal edges of the stents; 2 visualization of the stent struts; 3 presence of underexpansion and 4 calcifications. Stent diameters were quantitatively measured using dedicated QCA and SE software and compared to chart diameters according to the pressure of implantation. (3) Results: A total of 249 ESI sequences were qualitatively compared. Inter-observer variability was noted for strut visibility and total scores. Inter-observer agreement was found for the assessment of proximal stent edge and stent underexpansion. The predicted chart diameters were 0.31 ± 0.30 mm larger than SE diameters (p < 0.05). Stent diameters by SE after post-dilatation were 0.47 ± 0.31 mm smaller than the post-dilation balloon diameter (p < 0.05). SE-derived diameters significantly differed from QCA; by Bland–Altman analysis the bias was −0.37 ± 0.42 mm (p < 0.001). (4) Conclusions: SE provides an enhanced visualization and allows precise quantitative assessment of stent expansion without the limitations of QCA when overlapping coronary side branches are present.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Ghafari, Chadi ; Université de Mons - UMONS > Faculté de Médecine et de Pharmacie > Service de Cardiologie
Houissa, Khalil ; Université de Mons - UMONS > Faculté de Médecine et de Pharmacie > Cardiologie ; Department of Cardiology, Military Hospital of Tunis, Tunis, Tunisia
Neumann F.J. Sechtem U. Banning A.P. Bonaros N. Bueno H. Bugiardini R. Chieffo A. Crea F. Czerny M. Delgado V. et al. 2019 ESC Guidelines for the Diagnosis and Management of Chronic Coronary Syndromes Eur. Heart J. 2020 41 407 477 10.1093/eurheartj/ehz425
Kawaguchi R. Angiolillo D.J. Futamatsu H. Suzuki N. Bass T.A. Costa M.A. Stent Thrombosis in the Era of Drug Eluting Stents Minerva Cardioangiol. 2007 55 199 211 17342038
Gopalakrishnan M. Lotfi A. Stent Thrombosis Semin. Thromb. Hemost. 2018 44 046 051 10.1055/s-0037-1606178 28992649
Choi S.Y. Maehara A. Cristea E. Witzenbichler B. Guagliumi G. Brodie B. Kellett M.A. Dressler O. Lansky A.J. Parise H. et al. Usefulness of Minimum Stent Cross Sectional Area as a Predictor of Angiographic Restenosis after Primary Percutaneous Coronary Intervention in Acute Myocardial Infarction (from the HORIZONS-AMI Trial IVUS Substudy) Am. J. Cardiol. 2012 109 455 460 10.1016/j.amjcard.2011.10.005
Serruys P.W. Kay I.P. Disco C. Deshpande N.V. De Feyter P.J. Periprocedural Quantitative Coronary Angiography after Palmaz-Schatz Stent Implantation Predicts the Restenosis Rate at Six Months: Results of a Meta-Analysis of the Belgian Netherlands Stent Study (BENESTENT) I, BENESTENT II Pilot, BENESTENT II and MUSIC J. Am. Coll. Cardiol. 1999 34 1067 1074 10.1016/S0735-1097(99)00308-3
Fujii K. Carlier S.G. Mintz G.S. Yang Y.M. Moussa I. Weisz G. Dangas G. Mehran R. Lansky A.J. Kreps E.M. et al. Stent Underexpansion and Residual Reference Segment Stenosis Are Related to Stent Thrombosis after Sirolimus-Eluting Stent Implantation: An Intravascular Ultrasound Study J. Am. Coll. Cardiol. 2005 45 995 998 10.1016/j.jacc.2004.12.066 15808753
Okabe T. Mintz G.S. Buch A.N. Roy P. Hong Y.J. Smith K.A. Torguson R. Gevorkian N. Xue Z. Satler L.F. et al. Intravascular Ultrasound Parameters Associated with Stent Thrombosis After Drug-Eluting Stent Deployment Am. J. Cardiol. 2007 100 615 620 10.1016/j.amjcard.2007.03.072 17697816
Moussa I. Di Mario C. Reimers B. Akiyama T. Tobis J. Colombo A. Subacute Stent Thrombosis in the Era of Intravascular Ultrasound-Guided Coronary Stenting without Anticoagulant: Frequency, Predictors and Clinical Outcome J. Am. Coll. Cardiol. 1997 29 6 12 10.1016/S0735-1097(96)00452-4 8996288
Choi S.Y. Witzenbichler B. Maehara A. Lansky A.J. Guagliumi G. Brodie B. Kellett M.A. Dressler O. Parise H. Mehran R. et al. Intravascular Ultrasound Findings of Early Stent Thrombosis after Primary Percutaneous Intervention in Acute Myocardial Infarction: A Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) Substudy Circ. Cardiovasc. Interv. 2011 4 239 247 10.1161/CIRCINTERVENTIONS.110.959791
Cheneau E. Leborgne L. Mintz G.S. Kotani J. Pichard A.D. Satler L.F. Canos D. Castagna M. Weissman N.J. Waksman R. Predictors of Subacute Stent Thrombosis: Results of a Systematic Intravascular Ultrasound Study Circulation 2003 108 43 47 10.1161/01.CIR.0000078636.71728.40
Nerlekar N. Cheshire C.J. Verma K.P. Ihdayhid A.R. McCormick L.M. Cameron J.D. Bennett M.R. Malaiapan Y. Meredith I.T. Brown A.J. Intravascular Ultrasound Guidance Improves Clinical Outcomes during Implantation of Both First-and Second generation Drug-Eluting Stents: A Meta-Analysis EuroIntervention 2017 12 1632 1642 10.4244/EIJ-D-16-00769
Buccheri S. Franchina G. Romano S. Puglisi S. Venuti G. D’Arrigo P. Francaviglia B. Scalia M. Condorelli A. Barbanti M. et al. Clinical Outcomes Following Intravascular Imaging-Guided Versus Coronary Angiography–Guided Percutaneous Coronary Intervention with Stent Implantation: A Systematic Review and Bayesian Network Meta-Analysis of 31 Studies and 17,882 Patients JACC Cardiovasc. Interv. 2017 10 2488 2498 10.1016/j.jcin.2017.08.051
Maehara A. Matsumura M. Ali Z.A. Mintz G.S. Stone G.W. IVUS-Guided Versus OCT-Guided Coronary Stent Implantation: A Critical Appraisal JACC Cardiovasc. Imaging 2017 10 1487 1503 10.1016/j.jcmg.2017.09.008 29216976
Ghafari C. Carlier S. Stent Visualization Methods to Guide Percutaneous Coronary Interventions and Assess Long-Term Patency World J. Cardiol. 2021 13 416 437 10.4330/wjc.v13.i9.416 34621487
Truesdell A.G. Alasnag M.A. Kaul P. Rab S.T. Riley R.F. Young M.N. Batchelor W.B. Maehara A. Welt F.G. Kirtane A.J. Intravascular Imaging During Percutaneous Coronary Intervention: JACC State-of-the-Art Review J. Am. Coll. Cardiol. 2023 81 590 605 10.1016/j.jacc.2022.11.045 36754518
Lee J.M. Choi K.H. Song Y.B. Lee J.-Y. Lee S.-J. Lee S.Y. Kim S.M. Yun K.H. Cho J.Y. Kim C.J. et al. Intravascular Imaging–Guided or Angiography-Guided Complex PCI N. Engl. J. Med. 2023 388 1668 1679 10.1056/NEJMoa2216607
Tanaka N. Pijls N.H.J. Koolen J.J. Botman K.J. Michels H.R. Brueren B.R.G. Peels K. Shindo N. Yamashita J. Yamashina A. Assessment of Optimum Stent Deployment by Stent Boost Imaging: Comparison with Intravascular Ultrasound Heart Vessels 2013 28 1 6 10.1007/s00380-011-0202-9
Kastrati A. Mehilli J. Dirschinger J. Dotzer F. Schühlen H. Neumann F.J. Fleckenstein M. Pfafferott C. Seyfarth M. Schömig A. et al. Intracoronary Stenting and Angiographic Results: Strut Thickness Effect on Restenosis (Isar Stereo) Trial Circulation 2001 103 2816 2821 10.1161/01.CIR.103.23.2816
Pache J. Kastrati A. Mehilli J. Schühlen H. Dotzer F. Hausleiter J. Fleckenstein M. Neuman F.J. Sattelberger U. Schmitt C. et al. Intracoronary Stenting and Angiographic Results: Strut Thickness Effect on Restenosis Outcome (ISAR-STEREO-2) Trial J. Am. Coll. Cardiol. 2003 41 1283 1288 10.1016/S0735-1097(03)00119-0
Mutha V. Asrar Ul Haq M. Sharma N. Den Hartog W.F. Van Gaal W.J. Usefulness of Enhanced Stent Visualization Imaging Technique in Simple and Complex PCI Cases J. Invasive Cardiol. 2014 26 552 557
Doi H. Maehara A. Mintz G.S. Weissman N.J. Yu A. Wang H. Mandinov L. Popma J.J. Ellis S.G. Grube E. et al. Impact of In-Stent Minimal Lumen Area at 9 Months Poststent Implantation on 3-Year Target Lesion Revascularization–Free Survival Circ. Cardiovasc. Interv. 2008 1 111 118 10.1161/CIRCINTERVENTIONS.108.784660
Ohlmann P. Mintz G.S. Kim S.W. Pichard A.D. Satler L.F. Kent K.M. Suddath W.O. Waksman R. Weissman N.J. Intravascular Ultrasound Findings in Patients with Restenosis of Sirolimus- and Paclitaxel-Eluting Stents Int. J. Cardiol. 2008 125 11 15 10.1016/j.ijcard.2007.02.021
Iantorno M. Lipinski M.J. Garcia-Garcia H.M. Forrestal B.J. Rogers T. Gajanana D. Buchanan K.D. Torguson R. Weintraub W.S. Waksman R. Meta-Analysis of the Impact of Strut Thickness on Outcomes in Patients with Drug-Eluting Stents in a Coronary Artery Am. J. Cardiol. 2018 122 1652 1660 10.1016/j.amjcard.2018.07.040 30292330
Sanidas E.A. Maehara A. Barkama R. Mintz G.S. Singh V. Hidalgo A. Hakim D. Leon M.B. Moses J.W. Weisz G. Enhanced Stent Imaging Improves the Diagnosis of Stent Underexpansion and Optimizes Stent Deployment Catheter. Cardiovasc. Interv. 2013 81 438 445 10.1002/ccd.24353 22431198
Rogers R.K. Michaels A.D. Enhanced X-Ray Visualization of Coronary Stents: Clinical Aspects Cardiol. Clin. 2009 27 467 475 10.1016/j.ccl.2009.03.005
Zaid A.O. Hadded I. Belhaj W. Bouallegue A. Abdessalem S. Mechmeche R. Improved Localization of Coronary Stents Based on Image Enhancement Int. J. Biomed. Sci. 2008 4 212 216 23675092
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. 2018 70 21 26 10.1016/j.ehj.2017.09.001
Zhang J. Duan Y.Y. Jin Z.G. Wei Y.J. Yang S.L. Luo J.P. Ma D.X. Jing L.M. Liu H.L. Stent Boost Subtract Imaging for the Assessment of Optimal Stent Deployment in Coronary Ostial Lesion Intervention: Comparison with Intravascular Ultrasound Int. Heart J. 2015 56 37 42 10.1536/ihj.14-169
Davies A.G. Conway D. Reid S. Cowen A.R. Sivananthan M. Assessment of Coronary Stent Deployment Using Computer Enhanced X-Ray Images-Validation against Intravascular Ultrasound and Best Practice Recommendations Catheter. Cardiovasc. Interv. 2013 81 419 427 10.1002/ccd.23366
Blicq E. Georges J.L. Elbeainy E. Gibault-Genty G. Benjemaa K. Jerbi B. Livarek B. Detection of Stent Underdeployment by Stentboost Imaging J. Interv. Cardiol. 2013 26 444 453 10.1111/joic.12062
Omran O.M. Sherif M.H. Saied E.S. El-Ashmawy M.M. El-guindy A.D. El-den S.M.S. Evaluation of Coronary Stent Expansion during Percutaneous Coronary Interventions Using Stent Boost Visualization in Comparison with Intravascular Ultrasound J. Adv. Med. Med. Res. 2022 34 205 215 10.9734/jammr/2022/v34i1931454
Garrone P. Biondi-Zoccai G. Salvetti I. Sina N. Sheiban I. Stella P.R. Agostoni P. Quantitative Coronary Angiography in the Current Era: Principles and Applications J. Interv. Cardiol. 2009 22 527 536 10.1111/j.1540-8183.2009.00491.x 19627430
Lozano I. López-Palop R. Pinar E. Pérez-Lorente F. Picó F. Valdés M. Comparison between Theoretical and Actual Intracoronary Stent Dimensions in Non-Complex Lesions Rev. Española Cardiol. 2006 59 624 627 10.1157/13089751
De Ribamar Costa J. Mintz G.S. Carlier S.G. Costa R.A. Fujii K. Sano K. Kimura M. Lui J. Weisz G. Moussa I. et al. Intravascular Ultrasonic Assessment of Stent Diameters Derived from Manufacturer’s Compliance Charts Am. J. Cardiol. 2005 96 74 78 10.1016/j.amjcard.2005.02.049 15979438
Blasini R. Neumann F.J. Schmitt C. Bökenkamp J. Schömig A. Comparison of Angiography and Intravascular Ultrasound for the Assessment of Lumen Size after Coronary Stent Placement: Impact of Dilation Pressures Cathet. Cardiovasc. Diagn. 1997 42 113 119 10.1002/(SICI)1097-0304(199710)42:2<113::AID-CCD2>3.0.CO;2-G
Hong M.-K. Intravascular Ultrasound Predictors of Angiographic Restenosis after Sirolimus-Eluting Stent Implantation Eur. Heart J. 2006 27 1305 1310 10.1093/eurheartj/ehi882 16682378
Silva J.D. Carrillo X. Salvatella N. Fernandez-Nofrerias E. Rodriguez-Leor O. Mauri J. Bayes-Genis A. The Utility of Stent Enhancement to Guide Percutaneous Coronary Intervention for Bifurcation Lesions EuroIntervention 2013 9 968 974 10.4244/EIJV9I8A162 23774612
Cura F. Albertal M. Candiello A. Nau G. Bonvini V. Tricherri H. Padilla L.T. Belardi J.A. StentBoost Visualization for the Evaluation of Coronary Stent Expansion during Percutaneous Coronary Interventions Cardiol. Ther. 2013 2 171 180 10.1007/s40119-013-0023-2
Goto K. Mintz G.S. Litherland C. Lansky A.J. Weisz G. McPherson J.A. De Bruyne B. Serruys P.W. Stone G.W. Maehara A. Lumen Measurements from Quantitative Coronary Angiography and IVUS: A PROSPECT Substudy JACC Cardiovasc. Imaging 2016 9 1011 1013 10.1016/j.jcmg.2015.07.006 26363838
Jin Z. Yang S. Jing L. Liu H. Impact of StentBoost Subtract Imaging on Patient Radiation Exposure during Percutaneous Coronary Intervention Int. J. Cardiovasc. Imaging 2013 29 1207 1213 10.1007/s10554-013-0200-3
