J Cerebrovasc Endovasc Neurosurg.  2016 Sep;18(3):247-252. 10.7461/jcen.2016.18.3.247.

Clinical Utility of Angiographic CT with a Flat-detector Angiographic System during Endovascular Procedure

• Choi SW
• Jo KW
• Kim YW
• Kim SR
• Park IS
• Kim H

• KMID: 2355649
• DOI: http://doi.org/10.7461/jcen.2016.18.3.247

Abstract

OBJECTIVE
We evaluated the feasibility of angiographic computed tomography (ACT) for visualizing stent material in patients who underwent intracranial or extracranial stent placement to treat atherosclerotic lesions or stent assisted coil embolization.
MATERIALS AND METHODS
We performed intrarterial and intravenous ACT on biplane angiography system equipped with flat panel detectors (Axiom Arits dBA; Siemens Medical Solutions, Forchheim, Germany). Vistipaque 320 was injected for contrast medium, total 150 mL at flow rate of 5 mL/s through artery and 77 mL at flow rate of 3.5 mL/s through vein.
RESULTS
ACT is a new imaging modality that provides a clear visualization of stent strut.
CONCLUSION
Therefore this new application has potential to become the noninvasive option for follow-up after endovascular surgery using stents.

Keyword

Angiography; Digital subtraction; Tomography scanners; X-ray computed; Atherosclerosis

MeSH Terms

Angiography
Arteries
Atherosclerosis
Embolization, Therapeutic
Endovascular Procedures*
Follow-Up Studies
Humans
Stents
Veins

Figure

• 

  Fig. 1 (A) Stenosis, 85% (B) Precise 8 × 40 mm stent insertion. (C) Preop IA-ACT shows calcified plaque (arrow). (D) On axial views on post op IA and IV-ACT, the level of the plaque are showen. They further reveal the circumferential narrowing by calcified plaque (arrow). (E) Lateral ACT view (1 mm sections) provide superior visualization of the entire stent its strus and the remanining narrowing and show the underlying, heavialy calcified plaque(arrowhead) responsible for incomplete stent deployment. IA = intrarterial; ACT = angiographic computed tomography; IV = intravenous.

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  Fig. 2 (A) Severe stenosis of the right M1 segment. (B) Treatment with 2.5 × 8 mm durg eluting stent (Endeavor; Medtronic scientific, Roncadelle (BS), Italy) with successful, completely reestablishing the lumen (C) IA-ACT immediately after procedure show clear visualization of the stent and distal patency, also show no acute thrombosis. (D) IV-ACT after 3 month later show no instent stenois and clear stent struct. IA = intrarterial; ACT = angiographic computed tomography; IV = intravenous.

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  Fig. 3 (A) 3D DSA show unruptured aneurysm on paraclinoid aneurysm. (B) IA-ACT is performed after stent deployment and before coil embolizatoin. Excellent stent distal and proximal marker visibility and good position of stent is shown. (C) ACT image is performed after coil embolization allows definite exclusion of stent strut movement or coil protrusion with minimal beam-hardening artifacts. DSA = digital subtraction angiography; ACT = angiographic computed tomography.

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