Quantitative Analysis of Conebeam CT for Delineating Stents in Stent-Assisted Coil Embolization

Kuriyama, Takumi; Sakai, Nobuyuki; Beppu, Masatoshi; Sakai, Chiaki; Imamura, Hirotoshi; Masago, Katsuhiro; Katakami, Nobuyuki; Isoda, Haruo

doi:10.3174/ajnr.a5533

Cited by 9 publications

(6 citation statements)

References 16 publications

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“…HR-FDCT has helped improve stent visualization during neurointerventional procedures (Clarençon et al, 2017;Kuriyama et al, 2018;Srinivasan et al, 2018). Studies have explored its utility in patients with intracranial aneurysms [ (Caroff et al, 2014;Shintai et al, 2018;Kato et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

Application of High-Resolution Flat Detector Computed Tomography in Stent Implantation for Intracranial Atherosclerotic Stenosis

Wang

et al. 2021

Front. Neurosci.

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ObjectiveTo evaluate the utility of high-resolution flat-detector computed tomography (HR-FDCT) compared with conventional flat-detector computed tomography (FDCT) for stent placement in symptomatic intracranial atherosclerotic stenosis (ICAS).MethodsWe retrospectively reviewed the clinical data of 116 patients with symptomatic ICAS who underwent stent implantation. Images were acquired using conventional FDCT [voxel size = 0.43 mm (isotropic)] and HR-FDCT [voxel size = 0.15 mm (isotropic)]. Immediately after stent deployment, dual-volume three-dimensional (3D) fusion images were obtained from 3D digital subtraction angiography (DSA) and HR-FDCT. The image quality for stent visualization was graded from 0 to 2 (0: not able to assess; 1: limited, but able to assess; 2: clear visualization), and the stent-expansion status (“full,” “under-expanded” or “poor apposition”) was recorded.ResultsA total of 116 patients with symptomatic ICAS were treated successfully using 116 stents (58 NeuroformTM EZ, 42 EnterpriseTM, and 16 ApolloTM). The mean pre-stent stenosis was 80.5 ± 6.4%, which improved to 20.8 ± 6.9% after stenting. Compared with FDCT, HR-FDCT improved visualization of the fine structures of the stent to improve the image quality that significantly (mean score: 1.63 ± 0.60 vs. 0.41 ± 0.59, P < 0.001). In 19 patients, stent under-expansion (n = 11) or poor apposition (n = 8) was identified by HR-FDCT but not by conventional FDCT. After balloon dilatation, stent malapposition was shown to have improved on HR-FDCT. None of the 19 patients with stent malapposition experienced short-term complications during hospitalization or had in-stent stenosis at 6-month follow-up.ConclusionHigh-resolution flat-detector computed tomography (HR-FDCT) improves visualization of the fine structures of intracranial stents deployed for symptomatic ICAS compared with that visualized using conventional FDCT. High-resolution flat-detector computed tomography improves assessment of stent deployment and could reduce the risk of complications.

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Section: Discussionmentioning

confidence: 99%

Application of High-Resolution Flat Detector Computed Tomography in Stent Implantation for Intracranial Atherosclerotic Stenosis

Wang

et al. 2021

Front. Neurosci.

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“…However, this technique requires a special catheter insertion into the vessels in question. C-arm CT acquisition with a low contrast medium has become a common visualization technique for stents,7 as well as for intraprocedural evaluation of stent apposition during flow diverter stent deployment before stent plasty 5. However, these methods provide only 2D slice images 5 7 9.…”

Section: Discussionmentioning

confidence: 99%

“…C-arm CT acquisition with a low contrast medium has become a common visualization technique for stents,7 as well as for intraprocedural evaluation of stent apposition during flow diverter stent deployment before stent plasty 5. However, these methods provide only 2D slice images 5 7 9. In treatment with flow diverter stents, the assessment of stent apposition and its correction are indispensable to prevent delayed ischemic complications 8 9.…”

Section: Discussionmentioning

confidence: 99%

“…C-arm CT has also been applied with good results for the evaluation of stent apposition during flow diverter stent deployment before stent plasty 5. However, in these images, the precise structure of the stents and their three-dimensional (3D) spatial relation with the parent artery are difficult to evaluate 5 7 9…”

Section: Introductionmentioning

confidence: 99%

“…4 Stent apposition is usually evaluated based on a two-dimensional (2D) maximum intensity projection image acquired during the procedure by an angiographic C-arm system after the administration of a low concentration contrast medium. [5][6][7][8] C-arm CT has also been applied with good results for the evaluation of stent apposition during flow diverter stent deployment before stent plasty. 5 However, in these images, the precise structure of the stents and their three-dimensional (3D) spatial relation with the parent artery are difficult to evaluate.…”

Section: Introductionmentioning

confidence: 99%

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Visualization of stent apposition after stent-assisted coiling of intracranial aneurysms using high resolution 3D fusion images acquired by C-arm CT

Kato

Yuki

Ishibashi

et al. 2019

J NeuroIntervent Surg

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PurposeWe used an imaging technique based on 3-dimensional (3D) C-arm CT to assess the apposition of three types of stents after coiling of intracranial aneurysms.MethodsAll patients with intracranial aneurysms were considered who received stent-assisted coiling with Enterprise2, Neuroform EZ, or Neuroform Atlas stents confirmed by C-arm CT imaging at our institution between June 2015 and November 2017. A 3D digital subtraction angiography (DSA) scan for vessel imaging followed by a high-resolution cone beam CT (HR-CBCT) scan for coil and stent imaging was performed. The images were fused to obtain dual volume 3D fusion images. We investigated malapposition of the stent trunk (crescent sign) and of the stent edges (edge malapposition) and used the χ2 statistic to test for an association with stent types. Inter-rater agreement between two raters was estimated using Cohen’s kappa statistics.ResultsWe evaluated 75 consecutive cases. Enterprise2 stents were used in 22 cases, Neuroform EZ in 26, and Neuroform Atlas in 27 cases. By stent type, crescent sign was detected in 27% of Enterprise2, 8% of Neuroform EZ, and none of Neuroform Atlas stents (p=0.007), while edge malapposition was detected in 27% of Enterprise2, 58% of Neuroform EZ, and 30% of Neuroform Atlas stents (p=0.05). Excellent (κ=0.81) and good (κ=0.78) agreement between the raters was found for the detection of edge apposition and crescent sign, respectively.ConclusionStent malapposition was clearly visualized by dual volume 3D imaging. The Neuroform Atlas stents showed good apposition even in vessels with strong curvature.

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Visualization of flow diverter stent wall apposition during intracranial aneurysm treatment using a virtually diluted cone beam CT technique (Vessel ASSIST)

Hassan

Wise²,

Burke

et al. 2020

Neuroradiology

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Quantitative Analysis of Conebeam CT for Delineating Stents in Stent-Assisted Coil Embolization

Abstract: For stent-assisted coil embolization, quantitative assessment of conebeam CT showed that 10 second/1 × 1 was equivalent to 20 second/2 × 2 for imaging deployed intracranial stents. Furthermore, the 10-second/1 × 1 settings resulted in a much smaller DAP.

Cited by 9 publications

References 16 publications

Application of High-Resolution Flat Detector Computed Tomography in Stent Implantation for Intracranial Atherosclerotic Stenosis

Application of High-Resolution Flat Detector Computed Tomography in Stent Implantation for Intracranial Atherosclerotic Stenosis

Visualization of stent apposition after stent-assisted coiling of intracranial aneurysms using high resolution 3D fusion images acquired by C-arm CT

Visualization of flow diverter stent wall apposition during intracranial aneurysm treatment using a virtually diluted cone beam CT technique (Vessel ASSIST)

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