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  • Visualization of stent apposition after stent-assisted coiling of intracranial aneurysms using high resolution 3D fusion images acquired by C-arm CT

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Neuroimaging
Original research
Visualization of stent apposition after stent-assisted coiling of intracranial aneurysms using high resolution 3D fusion images acquired by C-arm CT
  1. Naoki Kato1,
  2. Ichiro Yuki1,2,
  3. Toshihiro Ishibashi1,
  4. Ayako Ikemura1,
  5. Issei Kan1,
  6. Kengo Nishimura1,
  7. Tomonobu Kodama1,
  8. Syougo Kaku1,
  9. Yukiko Abe3,
  10. Katharina Otani4,
  11. Yuichi Murayama1
  1. 1 Department of Neurosurgery, The Jikei University School of Medicine Tokyo, Tokyo, Japan
  2. 2 Department of Neurosurgery, University of California Irvine, Irvine, California, USA
  3. 3 Department of Radiology, Jikei University School of Medicine, Tokyo, Japan
  4. 4 AT Innovation Department, Siemens Healthcare K.K, Tokyo, Japan
  1. Correspondence to Dr Naoki Kato, Neurosurgery, The Jikei University School of Medicine Tokyo, Tokyo 105-8461, Japan; nao-kth{at}jikei.ac.jp

Abstract

Purpose We used an imaging technique based on 3-dimensional (3D) C-arm CT to assess the apposition of three types of stents after coiling of intracranial aneurysms.

Methods All patients with intracranial aneurysms were considered who received stent-assisted coiling with Enterprise2, Neuroform EZ, or Neuroform Atlas stents confirmed by C-arm CT imaging at our institution between June 2015 and November 2017. A 3D digital subtraction angiography (DSA) scan for vessel imaging followed by a high-resolution cone beam CT (HR-CBCT) scan for coil and stent imaging was performed. The images were fused to obtain dual volume 3D fusion images. We investigated malapposition of the stent trunk (crescent sign) and of the stent edges (edge malapposition) and used the χ2 statistic to test for an association with stent types. Inter-rater agreement between two raters was estimated using Cohen’s kappa statistics.

Results We evaluated 75 consecutive cases. Enterprise2 stents were used in 22 cases, Neuroform EZ in 26, and Neuroform Atlas in 27 cases. By stent type, crescent sign was detected in 27% of Enterprise2, 8% of Neuroform EZ, and none of Neuroform Atlas stents (p=0.007), while edge malapposition was detected in 27% of Enterprise2, 58% of Neuroform EZ, and 30% of Neuroform Atlas stents (p=0.05). Excellent (κ=0.81) and good (κ=0.78) agreement between the raters was found for the detection of edge apposition and crescent sign, respectively.

Conclusion Stent malapposition was clearly visualized by dual volume 3D imaging. The Neuroform Atlas stents showed good apposition even in vessels with strong curvature.

  • aneurysm
  • angiography
  • coil
  • CT
  • stent
https://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/neurintsurg-2019-014966

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    Footnotes

    • Contributors Conception and design: IY and YM. Data acquisition: NK, IY, TI, IK, KN, TK, SK, YA and YM. Analysis: NK, IK, YA and KO. Drafting the manuscript: NK, KO and YM. Critically revising the article: All authors. Final approval of the version to be published: All authors. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: All authors.

    • Funding This work was supported by Siemens Healthcare K.K. grant number C00221025.

    • Competing interests KO is an employee of Siemens Healthcare.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement There are no additional unpublished data available.

    • Patient consent for publication Not required.