28
Imaging
August 2013
New fluoroscopic imaging tool could help to avoid periprocedural complications
A study published in EuroIntervention indicates that StentBoost (Philips), which is a novel fluoroscopic imaging technique, could be used to enhance stent visibility during percutaneous coronary intervention (PCI) procedures in patients with bifurcation lesions. Potentially, use of the technique could help to reduce periprocedural complications
J
oana Silva (Cardiovascular Intervention Unit, Cardiology Department, University Hospital Germans Trias i Pujol, Barcelona, Spain) and others commented that StentBoost was a novel imaging technique that enhanced stent visibility. They reported: “Through motion-corrected acquisition frames, an enhanced picture of the stent and its relation with the vessel wall is obtained.” They explained that the technique might be useful during PCI for bifurcation lesions because rewiring a side branch could be challenging with coronary angiography (the gold standard for evaluating and classifying of coronary stenoses), because stent structure visualisation was difficult after implantation. The authors noted: “The purpose of this study is to evaluate the improvement of stent visibility obtained with StentBoost and to summarise the potential role of this new imaging tool during bifurcation PCI. In the single-centre, prospective study, Silva et al assessed imaging data from consecutive patients with angiographic evidence of a significant bifurcation lesion and a clinical indication for PCI who underwent complex bifurcation angioplasty with the use of StentBoost. They wrote that StentBoost was used when fluoroscopic images were insufficient to guide bifurcation PCI, and the
main uses of StentBoost in the study were to obtain the stent expansion ratio after stent deployment, to provide guidance during side branch rewiring, aid stent positioning in a two-stent strategy, and to help positioning the balloons for post dilation and kissing balloon technique.
repositioning and trajectory confirmation.” The advantages of StentBoost, Silva et al reported, are that it does not require the insertion of additional devices into the coronary arteries, does not involve specific training of the operator or staff, and does not
Our results indicate that this technique can pro- vide valuable information through sev- eral stages of the procedure and avoid periprocedural complications
According to the authors, in the 97 patients who underwent angioplasty with StentBoost, StentBoost image quality was “generally good”. They reported: “In 79.6% of the cases, an optimal visualisation of the stent struts and guidewire was obtained; 19.4% had a suboptimal visualisation and 1% had poor visualisation.” Silva et al added that in three cases, StentBoost “enabled the identification of the guidewire and angioplasty balloon passing outside stent borders during rewiring of the side branch, allowing for their
increase radiation exposure or procedure time. They concluded: “Our results indicate that this technique can provide valuable information through several stages of the procedure (visualisation of guidewire, balloon and stent, strut opening at the side branch ostium, balloon and stent positioning, need for post dilation) and avoid periprocedural complications.” They added: “StentBoost allows for adequate ostium visualisation and is particularly sensitive to detect severe stent distortion.”
Stress cardiac MRI has excellent prognostic value
A systematic review and meta-analysis, published ahead of print in the Journal of the American College of Cardiology, indicates that a negative cardiac MRI stress study is associated with a low risk of cardiovascular death and myocardial infarction; therefore, the imaging modality has good prognostic value in patients with known or suspected coronary artery disease
S
tudy authors Michael Lipinski and Michael Salerno from the
Department of Medicine, Division of Cardiology, University of Virginia Health System, Charlottesville, USA, and others noticed that while prior meta-analyses had demonstrated that stress CMR had “excellent diagnostic accuracy for detecting significant coronary artery disease”, there were no meta-analyses summarising the prognostic utility of stress cardiac MRI. They added that several studies have investigated the prognostic value of cardiac MRI stress testing in coronary artery disease, but said these were “often limited” as they were small and single centred. Therefore, the authors performed a systematic review and meta-analysis of the published studies to better understand the prognostic benefits of the imaging modality. Lipinski et al reported: “Prognostic validation of stress cardiac MRI is critical as a negative stress cardiac MRI
can be reassuring that the patient has a very low risk for major adverse cardiovascular event.” Studies were included in the analysis and review if they used cardiac MRI stress testing to assess myocardial ischaemia and had at least six months of prognostic follow-up, but data from populations of patients with cardiomyopathy or with acute myocardial infarction within the last 14 days were excluded. Using this criteria, Lipinski et al identified 19 studies with a total of 11, 636 patients with known or suspected coronary artery disease undergoing stress cardiac MRI between them. They found that, overall, 32% of patients had a positive cardiac MRI and late gadolinium enhancement (LGE) was present in 29% of patients in studies that assessed LGE. According to the authors, patients with a positive cardiac MRI had a significantly higher annualised event rate of cardiovascular death compared with patients with a negative cardiac MRI (p<0.00002).
Patients with a positive cardiac MRI also had a significantly higher annualised event rate of non-fatal myocardial infarction (p<0.0005) than those with negative findings. Furthermore, patients whose cardiac MRI studies demonstrated LGE had a significantly increased annualised event rate of both cardiovascular death (p<0.04) and myocardial infarction (p<0.008) than patients without LGE.
Lipinski et al commented: “The findings of this systematic review and meta-analysis demonstrate that stress cardiac MRI provides excellent prognostic stratification of patients with known or suspected coronary artery disease.” They added that the data showed that patients with negative cardiac MRI had a 1% annual event rate of either cardiovascular death or myocardial infarction, which they said was a “comparable prognosis to those patients that have a negative stress
Michael Salerno
myocardial perfusion imaging or stress echocardiogram”. Concluding their findings, Lipinski et al commented: “In the current financial environment, these findings provide justification for prospective randomised trials to assess the comparative effectiveness of stress cardiac MRI in comparison to alternative stress testing modalities.”
Michael Salerno told Cardiovascular News: “This
is the first meta-analysis demonstrating the very high prognostic utility of stress cardiac MRI for predicting adverse events in patients with known or suspected coronary artery disease and further provides evidence that stress cardiac MRI should be considered an excellent alternative to more established techniques such as stress nuclear myocardial perfusion imaging or stress echocardiography.”
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40