Use of enhanced stent visualisation compared to angiography alone to guide percutaneous coronary intervention

McBeath, Kristin; Rathod, Krishnaraj S.; Cadd, Matthew; Beirne, Anne‐Marie; Guttmann, Oliver; Knight, Charles; Amersey, Rajiv; Bourantas, Christos V.; Wragg, Andrew; Smith, Elliot J.; Baumbach, Andreas; Mathur, Anthony; Jones, Daniel A.

doi:10.1016/j.ijcard.2020.08.016

Cited by 9 publications

(18 citation statements)

References 22 publications

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“…Besides its positive contributions, ESI related uoroscopy time and radiation exposure can be expected to be higher than standard PCI, but the ouroscopy time and radiation exposure of ESI-guided coronary procedures are comparable to that of conventional angiography-guided PCI (22,23). In our study, uoroscopy time and radiation exposure dose were compatible to the studies in literature (22,23).…”

Section: Discussionsupporting

confidence: 86%

“…In addition, this new innovative technology promises a practical and cost-effective clinical use. Emerging clinical studies investigating the impact of ESI to cardiology practice revealed that, ESI guided PCI is associated with lower rates of stent restenosis, target lesion revascularization in follow-up term and major adverse cardiovascular events compared with no use of ESI (21,22). Our study demonstrated that enhanced visualization of deployed coronary stent was associated with better post-interventional result measured as MLD.…”

Section: Discussionmentioning

confidence: 49%

“…Our study demonstrated that enhanced visualization of deployed coronary stent was associated with better post-interventional result measured as MLD. It can be deduced that ESI guided PCI provides better clinical outcome by means of better visualization of stent characteristics such as deployment status, which help needing for further postdilation and stent strut fracture assessment (9,22).…”

Section: Discussionmentioning

confidence: 99%

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Enhanced Stent Imaging System Guided Percutaneous Coronary Intervention Is Linked to Optimize Stent Placement

et al. 2022

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Stent under-expansion is a predictor of restenosis and stent thrombosis. It remains uncertain whether enhanced stent imaging (ESI) (CLEARstent) guidance can improve stent under-expansion. Our aim was to assess the effect of using ESI on stent under-expansion, after percutaneous coronary intervention (PCI) in a single center, cross-sectional observational study. Participants attending our cardiology clinic with stable angina or acute coronary syndrome, from March to September 2020 were recruited. A total of 164 patients who underwent post-PCI ESI (CLEARstent) were compared with 77 age- and sex-matched control patients. Post-procedural minimal lumen diameter (MLD) was calculated. The patients in the ESI-guided PCI group, had a median age of 61 (54–69 IQR 25-75) years and 76.8% (n = 126) were males. The patients in ESI-guided PCI group had a greater minimal lumen diameter compared with the X-ray guided PCI group (βeta coefficient:2.88 (95% CI:2.58–2.99) vs βeta coefficient 2.55 (95% CI 2.34–2.63), P < .001). Our finding supports the use of the ESI system to optimize stent placement as expressed by the MLD.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 49%

Section: Discussionmentioning

confidence: 99%

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Enhanced Stent Imaging System Guided Percutaneous Coronary Intervention Is Linked to Optimize Stent Placement

et al. 2022

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“…In addition, ESV system was proved an effective assistance in reducing the excessive overlap in implantation of bioresorbable vascular scaffold (14). Furthermore, the results in the study of McBeath et al (16) showing a signi cantly improved correlations of an ESV system and clinical outcome. Jin et al (19) pointed out that the use of an ESV system (Stentboost, Philips) can be performed with comparable radiation dose with conventional x-ray uoroscopy imaging and suggested that the operator's experience have an important impact on radiation dose.…”

Section: Discussionmentioning

confidence: 98%

“…Therefore, how to reduce the need for contrast media and radiation exposure while ensuring surgical safety and image quality is critical at procedure of PCI Recently, an enhanced stent visualization (ESV) system (CLEARstent and CLEARstent Live; Siemens Healthineers, Germany) has been developed and deployed, providing a clear display of stent deployment by fade in/ fade out imaging (CLEARstent) and real time stent enhancement (CLEARstent Live). Several studies have demonstrated the feasibility, utility and e cacy of this system in facilitating PCI procedures and associating with better clinical outcomes (12)(13)(14)(15)(16). However, there is limited study on the contrast media usage with use of ESV technique during PCI for the patient with complication of CKD.…”

Section: Introductionmentioning

confidence: 99%

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

Tian

Zhao

Yang

et al. 2022

Preprint

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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 the 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 radiation dose, however, few study reported the impact on contrast media with use of ESV systems. Methods: We retrospectively collected 124 patients with acute coronary syndromes underwent PCI from May 2020 to July 2021. Patients were divided into ESV-guided group (n = 64) and angiography-guided group (n = 60). Procedural parameters including contrast media volume, radiation exposure (in Air Kerma), number of cines, cine frames, fluoroscopy and procedure time were recorded and analyzed.Results: Groups were comparable for patient characteristics. A significant reduction in contrast media volume (179.41 ± 16.76 ml vs. 114.5 ± 13.56ml, p = 0.0001), radiation exposure (693.99 ± 351.04 mGy vs. 1439.45 ± 973.01 mGy, p = 0.001) and procedure time (47.75 ± 15.43 min vs. 65.88 ± 23.81 min, p = 0.029) 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 subgroup analysis in patients with CKD, which is of great significance in decreasing the occurrence of contrast-induced nephropathy and mitigating the progression of CKD and CHD.

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Real‐time respiratory motion compensated roadmaps for hepatic arterial interventions

et al. 2021

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Purpose During hepatic arterial interventions, catheter or guidewire position is determined by referencing or overlaying a previously acquired static vessel roadmap. Respiratory motion leads to significant discrepancies between the true position and configuration of the hepatic arteries and the roadmap, which makes navigation and accurate catheter placement more challenging and time consuming. The purpose of this work was to develop a dynamic respiratory motion compensated device guidance system and evaluate the accuracy and real‐time performance in an in vivo porcine liver model. Methods The proposed device navigation system estimates a respiratory motion model for the hepatic vasculature from prenavigational X‐ray image sequences acquired under free‐breathing conditions with and without contrast enhancement. During device navigation, the respiratory state is tracked based on live fluoroscopic images and then used to estimate vessel deformation based on the previously determined motion model. Additionally, guidewires and catheters are segmented from the fluoroscopic images using a deep learning approach. The vessel and device information are combined and shown in a real‐time display. Two different display modes are evaluated within this work: (1) a compensated roadmap display, where the vessel roadmap is shown moving with the respiratory motion; (2) an inverse compensated device display, where the device representation is compensated for respiratory motion and overlaid on a static roadmap. A porcine study including seven animals was performed to evaluate the accuracy and real‐time performance of the system. In each pig, a guidewire and microcatheter with a radiopaque marker were navigated to distal branches of the hepatic arteries under fluoroscopic guidance. Motion compensated displays were generated showing real‐time overlays of the vessel roadmap and intravascular devices. The accuracy of the motion model was estimated by comparing the estimated vessel motion to the motion of the X‐ray visible marker. Results The median (minimum, maximum) error across animals was 1.08 mm (0.92 mm, 1.87 mm). Across different respiratory states and vessel branch levels, the odds of the guidewire tip being shown in the correct vessel branch were significantly higher (odds ratio = 3.12, p < 0.0001) for motion compensated displays compared to a noncompensated display (median probabilities of 86 and 69%, respectively). The average processing time per frame was 17 ms. Conclusions The proposed respiratory motion compensated device guidance system increased the accuracy of the displayed device position relative to the hepatic vasculature. Additionally, the provided display modes combine both vessel and device information and do not require the mental integration of different displays by the physician. The processing times were well within the range of conventional clinical frame rates.

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Use of enhanced stent visualisation compared to angiography alone to guide percutaneous coronary intervention

Cited by 9 publications

References 22 publications

Enhanced Stent Imaging System Guided Percutaneous Coronary Intervention Is Linked to Optimize Stent Placement

Enhanced Stent Imaging System Guided Percutaneous Coronary Intervention Is Linked to Optimize Stent Placement

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

Real‐time respiratory motion compensated roadmaps for hepatic arterial interventions

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