Stent fracture detected with a novel fluoroscopic stent visualization technique - StentBoost

Procedural Software Toolkit in the Armamentarium of Interventional Therapies: A Review of Additive Usefulness and Current Evidence

Interventional radiology is a fast-paced specialty that uses many advanced and emerging technological solutions. Several procedural hardware and software products are available commercially. Image-guided procedural software helps save time and effort in interventionist practice and adds precision to the intraoperative decisions made by the end user. Interventional radiologists, including interventional oncologists, have access to a wide range of commercially available procedural software that can be integrated into their workflow. However, the resources and real-world evidence related to such software are limited. Thus, we performed a detailed review of the current resources available, such as software-related publications, vendors' multimedia materials (e.g., user guides), and each software's functions and features, to compile a resource for interventional therapies. We also reviewed previous studies that have verified the use of such software in angiographic suites. Procedural software products will continue to increase in number and usage; these will likely be advanced further with deep learning, artificial intelligence, and new add-ins. Therefore, classifying procedural product software can improve our understanding of these entities. This review significantly contributes to the existing literature because it highlights the lack of studies on procedural product software.

Detection of very delayed coronary stent fracture using a novel fluoroscopic stent visualization technique against intravascular ultrasound: A case series

RATIONALE

Stent fracture has received increased concern as it may be an important risk factor for late stent failure, intravascular ultrasound (IVUS) is always recommended to confirm the diagnosis of stent fracture. StentBoost can detect stent fractures more easily due to the enhanced stent strut visibility, compared with coronary angiography (CAG). Few cases were reported to compare the advantages of StentBoost vis-à-vis IVUS in detecting stent fracture.

PATIENT CONCERNS

We reported 3 cases that were confirmed the diagnosis of stent fracture by StentBoost, which were preliminarily suspected by angiography, including one case that lacked the IVUS evidence of stent fracture.

DIAGNOSES

3 cases of stent fracture presented with asymptomatic, angina and acute myocardial infarction, respectively.

INTERVENTION

Stents were implanted in the patients of case 2 and case 3, but the patient of case 1 was not given any intervention.

OUTCOMES

No recurrent angina or myocardial infarction during outpatient follow-up.

LESSONS

StentBoost may distinguish partial, complete, or multiple stent fracture, even which sometimes is not obvious in IVUS, StentBoost is a useful and handy tool for identifying the stent struts.

Detection of Stent Underdeployment by StentBoost Imaging

OBJECTIVE

To evaluate the additional value of StentBoost® (SB), a motion-corrected X-ray technique that enhances stent visualization, for the assessment of stent deployment and procedure optimization during routine percutaneous coronary interventions (PCI).

BACKGROUND

Underdeployment and malapposition of stents during PCI may lead to in-stent thrombosis and restenosis. Coronary angiography (CA) is of limited value for the assessment of stent deployment. Intravascular ultrasound and optical imaging techniques are the gold standard, but are used in <10% of routine PCIs.

METHODS

We retrospectively analyzed 260 coronary lesions treated by stent implantation and assessed by SB during 168 consecutive PCI procedures. The immediate results of SB analysis and CA were assessed by 2 independent interventional cardiologists and compared.

RESULTS

A total of 275 stents were implanted; 45% were drug-eluting stents (DES). Direct stenting was performed in 78%. Results of SB and angiography were concordant for 210 lesions: 194 stents were correctly deployed (75%) and 16 were underdeployed (6%), shown by both techniques. In 47 patients (18%), SB detected an underdeployment of the stent whereas the angiographic result was good. Postdilatation was performed on the basis of SB in 89% of these cases. The additional contribution of SB was higher for left main lesions and for DES, and was not affected by coronary calcifications.

CONCLUSIONS

This study confirmed the usefulness of the stent visualization enhancement technique StentBoost® in current PCI practice. SB revealed about 20% underdeployed stents not detected by CA, and allowed for optimizing PCI by ad hoc effective postdilatation.

Clinical applications of a new Enhanced Stent Imaging technology

Enhanced Stent Imaging (ESI) refers to a rapidly evolving class of imaging tools that seek to provide enhanced visualization of coronary stent architecture with minimal disruption to the catheterization laboratory workflow. Various ESI stent platforms are available, all of which utilize a brief cine acquisition of a deflated balloon within a stent to generate a motion-corrected, enhanced image of the stent. The enhanced image permits detailed assessment of stent architecture, integrity, and positioning relative to other stents. We present two illustrative cases of percutaneous coronary intervention utilizing a new ESI platform. The relevant literature is briefly reviewed.

Assessment of coronary stent deployment using computer enhanced x-ray images-validation against intravascular ultrasound and best practice recommendations

OBJECTIVE

To investigate the accuracy of stent measurements using coronary x-ray angiograms with a computer based stent enhancement algorithm applied (StentBoost, SB). To derive recommendations for best practice when using such systems.

BACKGROUND

Computer enhancement algorithms allow better visualization of intracoronary stents to assist in ensuring adequate stent deployment. Factors that affect the accuracy of measurements taken on such systems are yet to be fully understood.

METHODS

We analysed stent deployment of 43 stents in 33 patients measuring minimum stent diameter and cross sectional area (CSA) using intravascular ultrasound (IVUS), SB enhanced x-ray images, and quantitative coronary angiography (QCA). We investigated if the use of two projections and method of calibration influenced correlation between IVUS and SB measurements.

RESULTS

Using two views and performing calibration via the guide catheter improved agreement between SB and IVUS measurements. For example, minimum stent diameter assessed with SB using one view and balloon markers for calibration produced a correlation coefficient, r, of 0.21, whereas using two views and the guide catheter for calibration increased agreement to r = 0.62. Relative measures of stent deployment, such as the ratio of minimum to maximum CSA, produced good correlation between IVUS and SB (r = 0.74).

CONCLUSIONS

When using the SB system, two projection angles should be used to image the stent. For absolute measurements, the guide catheter should be used for calibration purposes. Relative measures of stent size, which are probably sufficient for assessment of deployment, also give good agreement with similar measures on IVUS, and require no calibration.

Circumferential stent fracture: novel detection and treatment with the use of StentBoost

Circumferential stent fracture is extremely uncommon, and in rare cases, it can cause stent thrombosis. Recognizing stent fracture can be difficult on conventional fluoroscopy because of poor stent radiopacity. We found that StentBoost image acquisition yields improved visibility of stent struts, enabling the identification of stent fracture and the precise positioning of new stents over previously stented segments.We report the case of a 50-year-old man who presented with acute myocardial infarction and subacute stent thrombosis a week after percutaneous transluminal coronary angioplasty and placement of a bare-metal stent. The new lesion was crossed with a guidewire, but multiple attempts to advance a balloon catheter were unsuccessful. Live StentBoost image acquisition revealed circumferential stent fracture into 2 separate sections, with abnormal angulation between the proximal and distal portions of the stent. With StentBoost guidance, the wire and balloon catheter were both easily manipulated to cross the lesion, and angioplasty and restenting were completed with good results.StentBoost can be a useful adjunctive tool for the cardiac interventionist during complex percutaneous transluminal coronary angioplasty, and it was invaluable in this challenging situation. We discuss stent fracture and the benefits of using StentBoost in such situations.

Real-time 3D imaging in the cardiac catheterization laboratory

Worldwide experience in coronary catheterization and angiography for the detection and evaluation of lumen narrowing is extensive. Conventional coronary angiography analysis is complex since these arteries are of relatively small caliber and in constant movement, while being synchronized with the movement of the heart chambers and respiratory system. Moreover, atherosclerotic plaques in the coronary tree are themselves very intricate and frequently positioned in eccentric locations. The last decade has witnessed significant advances as novel data acquisition and processing techniques have been introduced. Researchers have developed novel processing systems that make it possible to construct 3D images in real-time during coronary intervention. The most common solutions are rotational imaging and reconstruction from multiple single-plane images. These techniques produce real-time 3D images of the coronary arteries in the catheterization laboratory. This article describes these state-of-the-art imaging methods and other specific novel applications in clinical practice, such as stent enhancement, guidance during transcatheter aortic valve implantation and advanced geometrical analysis with computational fluid dynamics.