Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Interventional Institute of Zhengzhou University, Zhengzhou, China.
Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Interventional Institute of Zhengzhou University, Zhengzhou, China.
J Clin Neurosci. 2022 Sep;103:14-19. doi: 10.1016/j.jocn.2022.06.028. Epub 2022 Jul 5.
It is well-established that complete expansion and proper apposition to the vessel wall of flow-diverter stents are critical for optimizing endovascular aneurysm outcomes by using flow diversion techniques. We aimed to evaluate the clinical value of high-resolution cone-beam CT (HR-CBCT) upon flow-diverter stent implantation in intracranial aneurysms. In this study, we retrospectively analyzed the clinical data of eighty-one patients (101 intracranial aneurysms) who underwent flow-diverter stent implantation (Pipeline™ or Tubridge™). Images were reconstructed using conventional cone-beam CT (CBCT)(voxel size 0.43 mm isotropic) and HR-CBCT(voxel size 0.15 mm isotropic). Immediately after stent deployment, dual volume 3D fusion images were obtained from 3D-digital subtraction angiography (DSA) and HR-CBCT. 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 also recorded. Finally, patients were treated using flow-diverter stents (n = 92: 17 Pipeline and 75 Tubridge). Compared to CBCT, HR-CBCT led to improved visualization of the structures of the stents and significantly improved the image quality (mean score: 0.59 ± 0.67 vs. 1.6 ± 0.63, P < 0.001). For 28 stents (seven Pipeline and 21 Tubridge), partially incomplete apposition was observed by HR-CBCT but not by conventional CBCT and resolved by microguidewire looping dilation or balloon dilation. High-resolution cone-beam CT could better display flow-diverter stent details and yielded an improved image quality, which facilitated the assessment of stent deployment, potentially reducing the incidence of complications.
已证实，通过血流导向技术，完全扩张和适当贴合到血管壁对于优化血管内动脉瘤治疗结果至关重要。我们旨在评估高分辨率锥形束 CT（HR-CBCT）在颅内动脉瘤血流导向支架植入术中的临床价值。在这项研究中，我们回顾性分析了 81 例（101 个颅内动脉瘤）接受血流导向支架植入术（Pipeline™或 Tubridge™）的患者的临床资料。使用常规锥形束 CT（CBCT）（体素大小 0.43mm 各向同性）和 HR-CBCT（体素大小 0.15mm 各向同性）进行图像重建。支架植入后，立即从 3D 数字减影血管造影（DSA）和 HR-CBCT 获得双容积 3D 融合图像。支架可视化的图像质量从 0 到 2 分级（0：无法评估，1：有限，但可评估；2：清晰可视化），并记录支架扩张状态（完全、未扩张或贴合不良）。最后，使用血流导向支架治疗患者（n=92：17 个 Pipeline 和 75 个 Tubridge）。与 CBCT 相比，HR-CBCT 改善了支架结构的可视化效果，显著提高了图像质量（平均评分：0.59±0.67 与 1.6±0.63，P<0.001）。对于 28 个支架（7 个 Pipeline 和 21 个 Tubridge），HR-CBCT 观察到部分不完全贴合，但常规 CBCT 未观察到，并通过微导丝环圈扩张或球囊扩张解决。高分辨率锥形束 CT 可以更好地显示血流导向支架的细节，改善图像质量，有助于评估支架的放置，可能降低并发症的发生率。
