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Coronary bifurcation stent morphology in dual-source CT: validation with micro-CT

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Abstract

The aim of this study is to analyze post-bifurcation coronary stent morphology in vitro using dual-source CT and validate those findings using micro-CT. Nine silicon coronary artery phantoms simulating main branch (MB) and side branch (SB) were prepared using a 3-D printer. After bifurcation stenting using Crush, Culotte, and T-stenting technique, in vitro CT imaging was conducted using both dual-source CT and micro-CT. Morphological change of the bifurcation stent including crushed segment and floating stent strut were evaluated. Dual-source CT was able to demonstrate morphologic changes of bifurcation stents and was comparable to micro-CT. In stents with Crush and T-stenting methods, crushed segment appeared denser and thicker than other stent parts and was located at MB side in all phantoms. Floating strut was observed in half of the phantoms with Crush technique and all phantoms with T-stenting. Parameters measured in both dual-source CT and micro-CT showed good correlation and high agreement (limits of agreement and correlation for length, perimeter and area, 0.3 ± 3.5, 0.5 ± 2.1 mm, and 0.0 ± 1.5 mm², r = 0.76, 0.92, and 0.91). The morphology of post-bifurcation stent on dual-source CT correlates well with that of micro-CT in the coronary artery phantom. Coronary CT angiography may be a feasible method for the evaluation of stent morphology in patients who underwent bifurcation stenting.

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References

  1. Latib A, Colombo A, Sangiorgi GM (2009) Bifurcation stenting: current strategies and new devices. Heart 95:495–504

    Article  CAS  PubMed  Google Scholar 

  2. Moses JW, Leon MB, Popma JJ, Fitzgerald PJ, Holmes DR, O’Shaughnessy C et al (2003) Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery. N Engl J Med 349:1315–1323

    Article  CAS  PubMed  Google Scholar 

  3. Maeng M, Holm NR, Erglis A, Kumsars I, Niemela M, Kervinen K et al (2013) Long-term results after simple versus complex stenting of coronary artery bifurcation lesions: Nordic bifurcation Study 5-year follow-up results. J Am Coll Cardiol 62:30–34

    Article  PubMed  Google Scholar 

  4. Steigen TK, Maeng M, Wiseth R, Erglis A, Kumsars I, Narbute I et al (2006) Randomized study on simple versus complex stenting of coronary artery bifurcation lesions: the Nordic bifurcation study. Circulation 114:1955–1961

    Article  PubMed  Google Scholar 

  5. Erglis A, Kumsars I, Niemela M, Kervinen K, Maeng M, Lassen JF et al (2009) Randomized comparison of coronary bifurcation stenting with the crush versus the culotte technique using sirolimus eluting stents: the Nordic stent technique study. Circ Cardiovasc Interv 2:27–34

    Article  PubMed  Google Scholar 

  6. Ormiston JA, Currie E, Webster MW, Kay P, Ruygrok PN, Stewart JT et al (2004) Drug-eluting stents for coronary bifurcations: insights into the crush technique. Catheter Cardiovasc Interv 63:332–336

    Article  PubMed  Google Scholar 

  7. Costa MA, Sabate M, Angiolillo DJ, Jimenez-Quevedo P, Teirstein P, Carter A et al (2006) Intravascular ultrasound characterization of the “black hole” phenomenon after drug-eluting stent implantation. Am J Cardiol 97:203–206

    Article  CAS  PubMed  Google Scholar 

  8. Nasu K, Tsuchikane E, Katoh O, Vince DG, Virmani R, Surmely JF et al (2006) Accuracy of in vivo coronary plaque morphology assessment: a validation study of in vivo virtual histology compared with in vitro histopathology. J Am Coll Cardiol 47:2405–2412

    Article  PubMed  Google Scholar 

  9. Nikolaou K, Knez A, Rist C, Wintersperger BJ, Leber A, Johnson T et al (2006) Accuracy of 64-MDCT in the diagnosis of ischemic heart disease. Am J Roentgenol 187:111–117

    Article  Google Scholar 

  10. Lim HB, Hur G, Kim SY, Kim YH, Kwon SU, Lee WR et al (2008) Coronary stent fracture: detection with 64-section multidetector CT angiography in patients and in vitro. Radiology 249:810–819

    Article  PubMed  Google Scholar 

  11. Chung MS, Yang DH, Kim YH, Roh JH, Song J, Kang JW et al (2015) Stent fracture and longitudinal compression detected on coronary CT angiography in the first- and new-generation drug-eluting stents. Int J Cardiovasc Imaging. doi:10.1007/s10554-015-0798-4 (E-pub ahead of print)

    Google Scholar 

  12. Foin N, Torii R, Mortier P, De Beule M, Viceconte N, Chan PH et al (2012) Kissing balloon or sequential dilation of the side branch and main vessel for provisional stenting of bifurcations: lessons from micro-computed tomography and computational simulations. JACC Cardiovasc Interv 5:47–56

    Article  PubMed  Google Scholar 

  13. Foin N, Torii R, Alegria E, Sen S, Petraco R, Nijjer S et al (2013) Location of side branch access critically affects results in bifurcation stenting: insights from bench modeling and computational flow simulation. Int J Cardiol 168:3623–3628

    Article  CAS  PubMed  Google Scholar 

  14. Murasato Y (2007) Impact of three-dimensional characteristics of the left main coronary artery bifurcation on outcome of crush stenting. Catheter Cardiovasc Interv 69:248–256

    Article  PubMed  Google Scholar 

  15. Di Vito L, Yoon JH, Kato K, Yonetsu T, Vergallo R, Costa M et al (2014) Comprehensive overview of definitions for optical coherence tomography-based plaque and stent analyses. Coron Artery Dis 25:172–185

    Article  PubMed  Google Scholar 

  16. Pracon R, Opolski MP, Mintz GS, Pregowski J, Kruk M, Popma JJ et al (2014) Serial intravascular ultrasound analysis of stent strut distribution and fracture: an integrated analysis of the taxus IV, V, and VI trials. J Invasive Cardiol 26:501–511

    PubMed  Google Scholar 

  17. Kyono H, Guagliumi G, Sirbu V, Rosenthal N, Tahara S, Musumeci G et al (2010) Optical coherence tomography (OCT) strut-level analysis of drug-eluting stents (DES) in human coronary bifurcations. EuroIntervention 6:69–77

    Article  PubMed  Google Scholar 

  18. Taylor AJ, Cerqueira M, Hodgson JM, Mark D, Min J, O’Gara P et al (2010) ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 appropriate use criteria for cardiac computed tomography. J Cardiovasc Comput Tomogr 4:407 e401–433

    Article  Google Scholar 

  19. Jensen JS, Galloe A, Lassen JF, Erglis A, Kumsars I, Steigen TK et al (2008) Safety in simple versus complex stenting of coronary artery bifurcation lesions. The Nordic Bifurcation Study 14-month follow-up results. EuroIntervention 4:229–233

    Article  PubMed  Google Scholar 

  20. Hildick-Smith D, de Belder AJ, Cooter N, Curzen NP, Clayton TC, Oldroyd KG et al (2010) Randomized trial of simple versus complex drug-eluting stenting for bifurcation lesions: the British Bifurcation Coronary Study: old, new, and evolving strategies. Circulation 121:1235–1243

    Article  CAS  PubMed  Google Scholar 

  21. Chiastra C, Morlacchi S, Gallo D, Morbiducci U, Cardenes R, Larrabide I et al (2013) Computational fluid dynamic simulations of image-based stented coronary bifurcation models. J R Soc Interface 10:20130193

    Article  PubMed  PubMed Central  Google Scholar 

  22. Williams AR, Koo BK, Gundert TJ, Fitzgerald PJ, LaDisa JF Jr (2010) Local hemodynamic changes caused by main branch stent implantation and subsequent virtual side branch balloon angioplasty in a representative coronary bifurcation. J Appl Physiol 109:532–540

    Article  PubMed  Google Scholar 

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Funding

This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (NRF-2013R1A1A1058711) and a Grant of the Korean Healthcare Technology R&D Project, Ministry of Health and Welfare, Republic of Korea (HI12C0630).

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Correspondence to Dong Hyun Yang.

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All authors have no conflicts of interest to disclose.

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Dong Hyun Yang and Young-Hak Kim contributed equally to this work.

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Eom, HJ., Yang, D.H., Kim, YH. et al. Coronary bifurcation stent morphology in dual-source CT: validation with micro-CT. Int J Cardiovasc Imaging 32, 1659–1665 (2016). https://doi.org/10.1007/s10554-016-0953-6

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  • DOI: https://doi.org/10.1007/s10554-016-0953-6

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