New approach to quantitative angiographic assessment after stent implantation.

The new generation quantitative angiographic systems apply the interpolated technique to calculate the reference diameter at the site of the stenosis by integrating measurements of the segments proximal and distal to the stenosis. After stent implantation these measurements can be misleading as the treated segment, which is frequently larger than the adjacent not stented segments, is included in the measurements. The consequence is an overestimation of the reference diameter and the residual diameter stenosis. The present study was performed to compare this conventional technique of measurement with a new method which excludes the stented segment for the calculation of the reference diameter. Fifty-two lesions treated with poorly radiopaque stents (56% Palmaz-Schatz, 28% NIR, 10% Gianturco-Roubin, 6% Wallstent) expanded at high pressure (> = or 16 atm) were analyzed according to the conventional and stent excluded method. After stent implantation the reference diameter was 3.39 +/- 0.48 mm with conventional measurements and 3.02 +/- 0.45 mm with the stent excluded method (P < 0.05). The corresponding % diameter stenosis was 13 +/- 9 for the conventional technique and 1 +/- 13 for the stent excluded analysis (P < 0.05). The new approach to quantitative coronary analysis after stenting provides higher accuracy in reference diameter calculations and allows a more appropriate matching of stented segments with adjacent normal segments.

[1]  C von Birgelen,et al.  A word of caution on optimizing stent deployment in calcified lesions: acute coronary rupture with cardiac tamponade. , 1996, American heart journal.

[2]  J. B. Foley,et al.  Alterations in reference vessel diameter following intracoronary stent implantation: important consequences for restenosis based on percent diameter stenosis. , 1995, Catheterization and cardiovascular diagnosis.

[3]  C J Slager,et al.  Comparative validation of quantitative coronary angiography systems. Results and implications from a multicenter study using a standardized approach. , 1995, Circulation.

[4]  P Hall,et al.  Intracoronary stenting without anticoagulation accomplished with intravascular ultrasound guidance. , 1995, Circulation.

[5]  W. Desmet,et al.  In vivo comparison of different quantitative edge detection systems used for measuring coronary arterial diameters. , 1995, Catheterization and cardiovascular diagnosis.

[6]  S. Goldberg,et al.  Benefit of intracoronary ultrasound in the deployment of Palmaz-Schatz stents. , 1994, Journal of the American College of Cardiology.

[7]  E. Gronenschild,et al.  CAAS. II: A second generation system for off-line and on-line quantitative coronary angiography. , 1994, Catheterization and cardiovascular diagnosis.

[8]  J. Reiber,et al.  A new approach for the quantification of complex lesion morphology: the gradient field transform; basic principles and validation results. , 1994, Journal of the American College of Cardiology.

[9]  P. Serruys,et al.  Critical appraisal of quantitative coronary angiography and endoluminal stent implantation , 1994 .

[10]  Jan J. Gerbrands,et al.  Accuracy and precision of quantitative digital coronary arteriography; observer-, as well as short- and medium-term variabilities , 1994 .

[11]  C J Slager,et al.  Experimental validation of geometric and densitometric coronary measurements on the new generation Cardiovascular Angiography Analysis System (CAAS II). , 1993, Catheterization and cardiovascular diagnosis.