Benamer Hakim, Ramus Liliane, Haidar Hachem-Ali, Perier Matthieu, Saighi Bouaouina Mehdi, Amelot Sophie, Vaillant Régis
Department of Cardiology, ICV GVM La Roseraie, 93300 Aubervilliers, France.
Department of Cardiology, Foch Hospital, 92150 Suresnes, France.
Eur Heart J Imaging Methods Pract. 2025 May 28;3(2):qyaf065. doi: 10.1093/ehjimp/qyaf065. eCollection 2025 Jul.
Stent under-expansion is a well-known predictor of post-percutaneous coronary intervention (PCI) major adverse cardiovascular events (MACE). This article presents a new technique to image coronary stents in 3D in the cathlab utilizing only the angiographic equipment.
Thirty patients with an indication of PCI were consented and prospectively included. They underwent a 3D rotational angiography following stent deployment without contrast injection. The 3D reconstructions of the coronary stents were independently reviewed offline by three experienced interventional cardiologists. Image quality was assessed using a qualitative scale: Excellent (struts are highly contrasted and sharp), Good (struts are contrasted enough to be distinguished from the background), Fair (the overall shape of the stent can be assessed but the precise demarcation between struts and background may be ambiguous in some areas) or Limited (it is challenging to distinguish the struts from the background). The 3D stent reconstruction quality was evaluated as Excellent for 37.8% of the cases, Good for 33.3%, Fair for 22.2%, and Limited for 6.7%. Substantial to near-perfect agreement was observed among reviewers (weighted Cohen's kappa 0.8, 0.78, 0.82 for the three pairs of reviewers respectively). The 3D quality was significantly correlated with the BMI using the Spearman rank correlation coefficient (=0.74, -value < 0.001).
The study demonstrates that 3D rotational angiography is feasible during PCI. The 3D reconstructions were evaluated as excellent or good in most patients by three interventional cardiologists. Additional studies are necessary to validate the measurements with respect to intra-vascular imaging and evaluate the role of this new technique in stent optimization.
支架扩张不足是经皮冠状动脉介入治疗（PCI）后主要不良心血管事件（MACE）的一个众所周知的预测指标。本文介绍了一种仅利用血管造影设备在导管室对冠状动脉支架进行三维成像的新技术。
30例有PCI指征的患者签署知情同意书并被前瞻性纳入研究。他们在支架置入后未注射造影剂的情况下接受了三维旋转血管造影。三名经验丰富的介入心脏病专家在离线状态下独立对冠状动脉支架的三维重建图像进行评估。使用定性量表评估图像质量：优秀（支架小梁对比度高且清晰）、良好（支架小梁对比度足以与背景区分）、一般（可以评估支架的整体形状，但在某些区域支架小梁与背景之间的精确界限可能不明确）或有限（很难将支架小梁与背景区分开来）。三维支架重建质量评估为优秀的病例占37.8%，良好的占33.3%，一般的占22.2%，有限的占6.7%。评估者之间观察到高度一致（三位评估者两两之间的加权科恩kappa系数分别为0.8、0.78、0.82）。使用斯皮尔曼等级相关系数，三维质量与体重指数显著相关（=0.74，P值<0.001）。
该研究表明PCI期间三维旋转血管造影是可行的。三位介入心脏病专家对大多数患者的三维重建图像评估为优秀或良好。需要进一步研究以验证血管内成像测量结果，并评估这项新技术在支架优化中的作用。
