Stent deformation in bifurcation stenting with final kissing balloon inflation: in vivo demonstration with enhanced cine fluoroscopic imaging

Enhanced stent visualization system for percutaneous coronary intervention in patients with chronic kidney disease: effects on contrast media volume and radiation exposure

Objective

We aimed to assess the impact of using enhanced stent visualization (ESV) systems on contrast media volume and radiation dose in percutaneous coronary intervention (PCI), especially for patients with chronic kidney disease (CKD).

Background

Coronary heart disease (CHD) is associated with chronic kidney disease (CKD), as they share a similar pathological pathway. In addition, the iodinated contrast media used for angiography is a risk factor for contrast-associated acute kidney injury (CA-AKI), which could aggravate the progression of CKD. We hypothesized that ESV systems have the potential to reduce the use of contrast media as well as the radiation dose; however, few studies have reported the impact on contrast media with the use of ESV systems.

Methods

We retrospectively collected 124 patients with acute coronary syndrome who underwent PCI from May 2020 to July 2021. The patients were divided into the ESV-guided group (n = 64) and angiography-guided group (n = 60). Procedural parameters, including contrast media volume, radiation exposure (in Air Kerma-AK and Dose Area Product-DAP), number of cines, cine frames, fluoroscopy and procedure time, were recorded and analysed.

Results

The groups were comparable regarding the patient characteristics. There was a significant reduction in contrast media volume (174.7 ± 29.6 ml vs.132.6 ± 22.3 ml, p = 0.0001), radiation exposure (776 (499 - 1200) mGy vs. 1065 (791 - 1603) mGy, p = 0.002 in AK; 43 (37 - 73) Gycm2 vs. 80 (64 - 133) Gycm2, p = 0.030 in DAP) and procedure time (53.06 ± 21.20 min vs. 72.00 ± 30.55 min, p = 0.01) with the use of ESV systems. Similar results were observed in the subgroup analysis for the patients with CKD.

Conclusion

This study suggested that the use of ESV is associated with reduced contrast media usage, radiation dose and procedure time during PCI. The same results were observed in a subgroup analysis in patients with CKD, and this shows that ESV-guided PCI has the potential to reduce renal impairment and mitigate the progression of CKD for those CHD patients with CKD.

Enhanced stent visualization systems during PCI: A case series and review of literature

Enhanced stent visualization systems increase the amount and quality of information during percutaneous coronary interventions. When compared to imaging techniques such as intravascular ultrasound and optical coherence tomography, enhanced stent visualization systems are easy-to-use, as well as time and cost saving. They are useful during stent implantation, overlap, assessment of integrity, and expansion. We review the available data regarding enhanced stent visualization systems and we report 5 cases showing their current applications during percutaneous coronary interventions. <Learning objective: Enhanced stent visualization (ESV) systems are helpful especially during complex percutaneous coronary interventions (PCI). In everyday clinical practice, ESV systems can be used both along with and instead of intracoronary imaging systems. The present case series show the main current applications of ESV systems during complex PCI cases with a brief review of the available data.>.