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P-026 Improving radiographic visualization during intracranial stent deployment
  1. Y Li1,
  2. M Corriveau1,
  3. S Schafer2,
  4. A Ahmed1,
  5. D Niemann1,
  6. B Aagaard Kienitz1
  1. 1Neurosurgery, University of Wisconsin Hospitals and Clinics, Madison, WI
  2. 2Siemens Medical Solutions USA, Inc., Hoffman Estates, IL

Abstract

Background Self-expanding intracranial stents have altered the treatment paradigm of wide necked intracranial aneurysms. Newer intracranial stents offer multiple advantages including lower profiles and increased flexibility. However, in spite of these advantages fluoroscopic and plain radiographic visibility of stent struts remain limited particularly at the skull base. This often results in difficulty assessing stent position along perforating vessels and apposition along the parent artery wall.

Methods and materials A dedicated “Stent View” 2D digital radiography technique was established in our hospital using 7.5 Fr/s at 0.36 µGy/Fr. Three fellowship trained neurointerventionalists investigated the application of this technique in evaluation of stent deployment, torsion, and wall apposition. The method was used in 30 consecutive patients undergoing flow diverter placement as part of clinical routine. High-quality CBCT was acquired in the first 10 of the patients to confirm stent apposition. CBCT was omitted in the remaining patients and wall apposition was derived from standard follow up diagnostic images. Given the radiation dose, usage was restricted to device deployment alone to limit radiation exposure of the patient and operator.

Findings “Stent View” is a higher dose DR scene that improves visualization of intracranial stents with high intra and inter-rater reliability for the three imaging tasks when compared to standard fluoroscopy. The technique allows for instantaneous assessment of flow diverter torsion, the extent of stent deployment, and parent wall apposition to reduce rates of endo-leak and iatrogenic device deployment. In comparison to post-intervention volume of interest 3D rendered images, the evaluated technique is lower in radiation and superior in facilitating intra-operative technical adjustments.

Conclusion “Stent View” is a new widely available technique that augments visibility during intracranial stent placement. This technique may improve procedural safety and efficacy of stent-assisted aneurysm coiling.

Abstract P-026 Figure 1

(A) Contrast focused post processing of conventional DSA with accentuation of the intracranial vasculature making stent visualization difficult. (B) “Stent View” device focused post processing to facilities intra-procedural stent assessment, deployment, and manipulation. There is decreased fine vessel detail but enhancement of stent visualization.

Disclosures Y. Li: None. M. Corriveau: None. S. Schafer: None. A. Ahmed: None. D. Niemann: None. B. Aagaard Kienitz: None.

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