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Value of C-Arm Computed Tomography to Evaluate Stent Deployment During Femoro-Popliteal Revascularization

  • Clinical Investigation
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Abstract

Purpose

To compare the accuracy of C-arm computed tomography (CT) and digital subtraction angiography (DSA) in detecting incomplete stent expansion (ISE) after superficial femoral artery (SFA) stenting using intravascular ultrasound (IVUS) as a gold standard.

Materials

Fifty patients with symptomatic SFA occlusive disease requiring angioplasty were prospectively included. Once technical success (<30 % residual stenosis) was obtained on post-procedural DSA, C-arm CT and IVUS were acquired. DSA and C-arm CT examinations were reviewed by 2 investigators and correlated with IVUS. C-arm CT image quality was rated on a four-point scale. Doppler ultrasound was performed at 1-year follow-up.

Results

The ankle-brachial index was 0.69 ± 0.10 and 0.99 ± 0.40, respectively, pre- and post-procedure. C-arm CT imaging quality was rated as good or excellent in 80 %. In-stent minimal luminal diameter (MLD) was evaluated at 4.71 ± 0.7 mm on DSA, 3.39 ± 0.6 mm on IVUS, and 3.12 ± 0.9 mm on C-arm CT. Compared to IVUS, DSA demonstrated an overestimation of MLD (p = 0.0001), an underestimation of ISE (DSA = 18.8 % ± 7.6; IVUS = 29.8 % ± 9) (p < 0.0001), and a poor inter-technique intra-class correlation coefficient (ICC = 0.24). No difference was observed between IVUS and C-arm CT in ISE as calculated by diameter (29.8 ± 9 vs. 28.2 ± 12.5 %, p = 0.5) and area (30.2 ± 8.4 vs. 33.3 ± 9.5 %, p = 0.2). Inter-technique ICC between C-arm CT and IVUS was 0.72 [95 %CI 0.49; 0.85] for MLA measurements. The inter-observer ICC for MLD and MLA measurements on C-arm CT were, respectively, estimated at 0.75 [95 % CI 0.40, 0.89] and 0.77 [95 % CI 0.43, 0.90)].

Conclusions

C-arm CT presents a better correlation with IVUS than DSA to determine lumen diameter and ISE immediately after percutaneous revascularization.

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Acknowledgments

Gilles Soulez was supported for this work by the Canadian Institutes of Health Research through a collaborative research program with Siemens Medical Germany (Grant Number: CIHR ISO-83052), and a senior clinical research scholarship (to Gilles Soulez from the Fonds de la Recherche en Santé du Québec (FRSQ, Grant Ref: 9958)).

Conflict of Interest

Gerald Gahide, Sofian Hadjaj, Eric Therasse, Claude Kauffmann, Patrick Gilbert, Vincent L Oliva, Jean-Claude Tardif, Jacques Lesperance, and Guy Cloutier have no conflict of interest.

Statement of Human and Animal Rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Statement of Informed Consent

Informed consent was obtained from all individual participants included in the study.

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Gahide, G., Hadjadj, S., Therasse, E. et al. Value of C-Arm Computed Tomography to Evaluate Stent Deployment During Femoro-Popliteal Revascularization. Cardiovasc Intervent Radiol 38, 1458–1467 (2015). https://doi.org/10.1007/s00270-015-1108-1

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