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Clinical Impact of Flat Panel Volume CT Angiography in Evaluating the Accurate Intraoperative Deployment of Flow-Diverter Stents

Clinical Impact of Flat Panel Volume CT Angiography in Evaluating the Accurate Intraoperative... ORIGINAL RESEARCH INTERVENTIONAL Clinical Impact of Flat Panel Volume CT Angiography in Evaluating the Accurate Intraoperative Deployment of Flow-Diverter Stents X F.Clarenc¸on,X F.DiMaria,X J.Gabrieli,X E.Shotar,X V.Degos,X A.Nouet,X A.Biondi,andX N.-A.Sourour ABSTRACT BACKGROUND AND PURPOSE: Thedeploymentofflow-diverterstentsmaybedifficulttoanalyseonregularDSA.Thepurposeofour study was to investigate the clinical impact of stent-dedicated flat panel volume CT angiography to evaluate intraoperatively the satisfactorydeploymentofflow-diverterstents. MATERIALS AND METHODS: FromJanuary2009toApril2015,83consecutivepatients(meanage,51years;62women)weretreatedinour institution with flow-diverter stents. Eighty-seven aneurysms (82 unruptured, 5 ruptured; 77 anterior, 10 posterior circulation) were treated in these83patients(4patientshad2aneurysms,bothtreatedbymeansofflow-diverterstents).Onepatientwastreatedforatraumaticcarotid cavernous fistula. In 80% of the cases (68/85) a flat panel volume CT angiography was performed in the angiographic suite just after the flow-diverterstentdeployment.Stentvisualizationwasassessedby2independentreviewers.Theclinicalimpactofstentmalappositionwas evaluated. RESULTS: Flow-diverter stent visualization was satisfactory in 73.5% of the cases. In 2 cases (2.9%) the flat panel volume CT angiography promptedtheoperatortoperformanadditionalintrastentangioplastyforaconditionthatwaspreviouslyunderestimated.Fourpatients(4.7%) experiencedacutethromboemboliccomplications;3othershaddelayedthromboemboliccomplications.Only1ofthesepatientshadthrom- boembolic complications (acute or delayed) related to stent misdeployment, which was easily managed intraoperatively with no clinical consequence. CONCLUSIONS: FlatpanelvolumeCTangiographyisaninterestingtooltodepictflow-diverterstentmisdeploymentandmayencourage theoperatortoperformintrastentangioplasty(2.9%ofthecasesinourexperience)toreducetherisksofthromboemboliccomplications. ABBREVIATIONS: FDS flow-diverterstent;FPV-CTA flatpanelvolumeCTangiography low-diverter stents (FDSs) have gained acceptance in recent tion of their accurate deployment by the operator during the proce- F years for the treatment of intracranial aneurysms, especially dure. Flat panel volume CT angiography (FPV-CTA) is now increas- 1,2 giant and large ones. This new-generation stent shifted the para- ingly http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Neuroradiology American Journal of Neuroradiology

Clinical Impact of Flat Panel Volume CT Angiography in Evaluating the Accurate Intraoperative Deployment of Flow-Diverter Stents

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Publisher
American Journal of Neuroradiology
Copyright
© 2017 by American Journal of Neuroradiology
ISSN
0195-6108
eISSN
1936-959X
DOI
10.3174/ajnr.A5343
Publisher site
See Article on Publisher Site

Abstract

ORIGINAL RESEARCH INTERVENTIONAL Clinical Impact of Flat Panel Volume CT Angiography in Evaluating the Accurate Intraoperative Deployment of Flow-Diverter Stents X F.Clarenc¸on,X F.DiMaria,X J.Gabrieli,X E.Shotar,X V.Degos,X A.Nouet,X A.Biondi,andX N.-A.Sourour ABSTRACT BACKGROUND AND PURPOSE: Thedeploymentofflow-diverterstentsmaybedifficulttoanalyseonregularDSA.Thepurposeofour study was to investigate the clinical impact of stent-dedicated flat panel volume CT angiography to evaluate intraoperatively the satisfactorydeploymentofflow-diverterstents. MATERIALS AND METHODS: FromJanuary2009toApril2015,83consecutivepatients(meanage,51years;62women)weretreatedinour institution with flow-diverter stents. Eighty-seven aneurysms (82 unruptured, 5 ruptured; 77 anterior, 10 posterior circulation) were treated in these83patients(4patientshad2aneurysms,bothtreatedbymeansofflow-diverterstents).Onepatientwastreatedforatraumaticcarotid cavernous fistula. In 80% of the cases (68/85) a flat panel volume CT angiography was performed in the angiographic suite just after the flow-diverterstentdeployment.Stentvisualizationwasassessedby2independentreviewers.Theclinicalimpactofstentmalappositionwas evaluated. RESULTS: Flow-diverter stent visualization was satisfactory in 73.5% of the cases. In 2 cases (2.9%) the flat panel volume CT angiography promptedtheoperatortoperformanadditionalintrastentangioplastyforaconditionthatwaspreviouslyunderestimated.Fourpatients(4.7%) experiencedacutethromboemboliccomplications;3othershaddelayedthromboemboliccomplications.Only1ofthesepatientshadthrom- boembolic complications (acute or delayed) related to stent misdeployment, which was easily managed intraoperatively with no clinical consequence. CONCLUSIONS: FlatpanelvolumeCTangiographyisaninterestingtooltodepictflow-diverterstentmisdeploymentandmayencourage theoperatortoperformintrastentangioplasty(2.9%ofthecasesinourexperience)toreducetherisksofthromboemboliccomplications. ABBREVIATIONS: FDS flow-diverterstent;FPV-CTA flatpanelvolumeCTangiography low-diverter stents (FDSs) have gained acceptance in recent tion of their accurate deployment by the operator during the proce- F years for the treatment of intracranial aneurysms, especially dure. Flat panel volume CT angiography (FPV-CTA) is now increas- 1,2 giant and large ones. This new-generation stent shifted the para- ingly

Journal

American Journal of NeuroradiologyAmerican Journal of Neuroradiology

Published: Oct 1, 2017

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