Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.
Division of Vascular and Endovascular Surgery, Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Mass.
J Vasc Surg. 2019 Apr;69(4):1111-1120. doi: 10.1016/j.jvs.2018.07.038. Epub 2018 Oct 6.
Three-dimensional (3D) image fusion is associated with lower radiation exposure, contrast agent dose, and operative time during endovascular abdominal aortic aneurysm repair. Therefore, we evaluated the impact of this technology on carotid artery stenting (CAS).
We identified consecutive CAS procedures from 2009 to 2017 and compared those performed with and without 3D image fusion. For image fusion, we created a 3D reconstruction of the aortic arch anatomy based on preoperative computed tomography or magnetic resonance angiography that we merged with two-dimensional fluoroscopy, allowing 3D image overlay. We compared radiation exposure, fluoroscopy time, contrast agent dose, time to common carotid artery (CCA) cannulation, time from CCA cannulation to completion angiography, and total procedure time in procedures with and without image fusion. We also assessed rates of 30-day stroke/death, in-hospital and 30-day stroke, and acute kidney injury. We used multivariable linear regression to adjust for patient and procedural characteristics and used these models to compute the marginal effects of image fusion compared with no image fusion.
There were 46 patients who underwent CAS with a 3D image fusion system and 70 patients without. Patients undergoing CAS with image fusion experienced 31% lower radiation exposure compared with the control group (207 ± 23 mGy vs 300 ± 26 mGy, respectively; P < .01), shorter fluoroscopy time (21 ± 6 minutes vs 24 ± 8 minutes; P = .02), shorter time to carotid cannulation (21 ± 9 minutes vs 31 ± 8 minutes; P < .001), and shorter total procedure time (47 ± 13 minutes vs 54 ± 18 minutes; P = .03). There was no difference in contrast material volume, time from CCA cannulation to completion angiography, or total in-room time. After multivariable adjustment, 3D image fusion remained associated with lower radiation dose, shorter fluoroscopy time, and shorter time to carotid cannulation (all P < .05). The rate of 30-day stroke/death was 2.7% (three strokes and no deaths at 30 days), and the rate of acute kidney injury was 1.8%.
CAS with 3D image fusion was associated with lower radiation exposure and shorter time to CCA cannulation. These results represent the potential technical advantage gained with image fusion and add to the growing body of evidence demonstrating its impact on radiation exposure and operative times during complex endovascular procedures.
在血管内腹主动脉瘤修复术中，三维（3D）图像融合与较低的辐射暴露、对比剂剂量和手术时间相关。因此，我们评估了该技术对颈动脉支架置入术（CAS）的影响。
我们从 2009 年至 2017 年确定了连续的 CAS 手术，并比较了使用和不使用 3D 图像融合的手术。对于图像融合，我们基于术前计算机断层扫描或磁共振血管造影术创建了主动脉弓解剖结构的 3D 重建，然后将其与二维透视融合，允许进行 3D 图像叠加。我们比较了有和无图像融合的手术中的辐射暴露、透视时间、对比剂剂量、颈总动脉（CCA）穿刺时间、从 CCA 穿刺到完成血管造影的时间和总手术时间。我们还评估了 30 天内卒中/死亡率、住院期间和 30 天内卒中率以及急性肾损伤率。我们使用多变量线性回归来调整患者和手术特征，并使用这些模型来计算与无图像融合相比图像融合的边际效应。
有 46 例患者在 3D 图像融合系统下行 CAS 手术，70 例患者未行。与对照组相比，行 CAS 手术并使用图像融合的患者的辐射暴露量低 31%（分别为 207±23 mGy 和 300±26 mGy；P<0.01），透视时间短（21±6 分钟比 24±8 分钟；P=0.02），颈动脉穿刺时间短（21±9 分钟比 31±8 分钟；P<0.001），总手术时间短（47±13 分钟比 54±18 分钟；P=0.03）。造影剂用量、从 CCA 穿刺到完成血管造影的时间和总室内时间无差异。多变量调整后，3D 图像融合仍与较低的辐射剂量、较短的透视时间和较短的颈动脉穿刺时间相关（均 P<0.05）。30 天内的卒中/死亡率为 2.7%（30 天内 3 例卒中，无死亡），急性肾损伤发生率为 1.8%。
CAS 手术中使用 3D 图像融合与较低的辐射暴露和较短的 CCA 穿刺时间相关。这些结果代表了图像融合带来的潜在技术优势，并增加了越来越多的证据，证明其对复杂血管内手术中辐射暴露和手术时间的影响。
