Abstract
Objective
As stents for treating intracranial atherosclerotic stenosis may develop in-stent re-stenosis (ISR) in up to 30%, follow-up imaging is mandatory. Residual stenosis (RS) is not rare. We evaluated an optimised Flat Detector CT protocol with intravenous contrast material application (i.v. FD-CTA) for non-invasive follow-up.
Methods
In 12 patients with intracranial stents, follow-up imaging was performed using i.v. FD-CTA. MPR, subtracted MIP and VRT reconstructions were used to correlate to intra-arterial angiography (DSA). Two neuroradiologists evaluated the images in anonymous consensus reading and calculated the ISR or RS. Correlation coefficients and a Wilcoxon test were used for statistical analysis.
Results
In 4 patients, no stenosis was detected. In 6 patients RS and in two cases ISR by intima hyperplasia perfectly visible on MPR reconstructions of i.v. FD-CTA were detected. Wilcoxon’s test showed no significant differences between the methods (p > 0.05). We found a high correlation with coefficients of the pairs DSA/ FD-CT MIP r = 0.91, DSA/ FD-CT MPR r = 0.82 and FD-CT MIP/ FD-CT MPR r = 0.8.
Conclusion
Intravenous FD-CTA could clearly visualise the stent and the lumen, allowing ISR or RS to be recognised. FD-CTA provides a non-invasive depiction of intracranial stents and might replace DSA for non-invasive follow-up imaging.
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References
Bose A, Hartmann M, Henkes H, Liu HM, Teng MM, Szikora I et al (2007) A novel, self-expanding, nitinol stent in medically refractory intracranial atherosclerotic stenoses: the Wingspan study. Stroke 38:1531–1537
Levy EI, Turk AS, Albuquerque FC, Niemann DB, Aagaard-Kienitz B, Pride L et al (2007) Wingspan in-stent restenosis and thrombosis: incidence, clinical presentation, and management. Neurosurgery 61:644–650
Fiorella DJ, Levy EI, Turk AS, Albuquerque FC, Pride GL Jr, Woo HH et al (2009) Target lesion revascularization after wingspan: assessment of safety and durability. Stroke 40:106–110
Trossbach M, Hartmann M, Braun C, Sartor K, Hähnel S (2004) Small vessel stents for intracranial angioplasty: in vitro evaluation of in-stent stenoses using CT angiography. Neuroradiology 46:459–463
Willinsky RA, Taylor SM, TerBrugge K, Farb RI, Tomlinson G, Montanera W (2003) Neurologic complications of cerebral angiography: prospective analysis of 2, 899 procedures and review of the literature. Radiology 227:522–528
Kalender WA, Kyriakou Y (2007) Flat-detector computed tomography (FD-CT). Eur Radiol 17:2767–2779
Kalender WA (2003) The use of flat-panel detectors for CT imaging. Radiologe 43:379–387
Benndorf G, Strother CM, Claus B, Naeini R, Morsi H, Klucznik R et al (2005) Angiographic CT in cerebrovascular stenting. AJNR Am J Neuroradiol 26:1813–1818
Benndorf G, Klucznik RP, Strother CM (2006) Images in cardiovascular medicine: angiographic computed tomography for imaging of underdeployed intracranial stent. Circulation 114:e499–500
Struffert T, Doelken M, Adamek E, Schwarz M, Engelhorn T, Kloska S et al (2010) Flat-detector computed tomography with intravenous contrast material application in experimental aneurysms: comparison with multislice CT and conventional angiography. Acta Radiol 51:431–437
Struffert T, Deuerling-Zheng Y, Kloska S, Engelhorn T, Strother CM, Kalender WA et al (2010) A Flat Detector CT in the evaluation of brain parenchyma, intracranial vasculature, and cerebral blood volume: a pilot study in patients with acute symptoms of cerebral ischemia. AJNR Am J Neuroradiol. doi:10.3174/ajnr.A2083
Buhk JH, Lingor P, Knauth M (2008) Angiographic CT with intravenous administration of contrast medium is a noninvasive option for follow-up after intracranial stenting. Neuroradiology 50:349–354
Benndorf G, Claus B, Strother CM, Chang L, Klucznik RP (2006) Increased cell opening and prolapse of struts of a neuroform stent in curved vasculature: value of angiographic computed tomography: technical case report. Neurosurgery 4(Suppl 2):ONS-E380, discussion ONS-E380
Nguyen-Huynh MN, Wintermark M, English J (2008) How accurate is CT angiography in evaluating intracranial atherosclerotic disease? Stroke 39:1184–1188
SSYLVIA Study Investigators (2004) Stenting of Symptomatic Atherosclerotic Lesions in the Vertebral or Intracranial Arteries (SSYLVIA): study results. Stroke 35:1388–1392
Hartmann M, Jansen O (2005) Angioplasty and stenting of intracranial stenosis. Curr Opin Neurol 18:39–45
Prabhakaran S, Warrior L, Wells KR, Jhaveri MD, Chen M, Lopes DK (2009) The utility of quantitative magnetic resonance angiography in the assessment of intracranial in-stent stenosis. Stroke 40:991–993
Turk AS, Rowley HA, Niemann DB, Fiorella D, Aagaard-Kienitz B, Pulfer K et al (2007) CT angiographic appearance of in-stent restenosis of intracranial arteries treated with the Wingspan stent. AJNR Am J Neuroradiol 28:1752–1754
Buerke B, Wittkamp G, Seifarth H, Heindel W, Kloska SP (2009) Dual-energy CTA with bone removal for transcranial arteries: intraindividual comparison with standard CTA without bone removal and TOF-MRA. Acad Radiol 16:1348–1355
Albuquerque FC, Levy EI, Turk AS, Niemann DB, Aagaard-Kienitz B, Pride GL Jr (2008) Angiographic patterns of Wingspan in-stent restenosis. Neurosurgery 63:23–27
Prell D, Kyriakou Y, Struffert T, Dörfler A, Kalender WA (2010) Metal artifact reduction for clipping and coiling in interventional C-arm CT. AJNR Am J Neuroradiol 31:634–649
Buhk JH, Kallenberg K, Mohr A, Dechent P, Knauth M (2009) Evaluation of angiographic computed tomography in the follow-up after endovascular treatment of cerebral aneurysms–a comparative study with DSA and TOF-MRA. Eur Radiol 19:430–6
Acknowledgements
Yu Deuerling-Zheng is an employee of Siemens AG and provided installation of this new DynaCT program. The DynaCT program has got a CE mark.
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Struffert, T., Kloska, S., Engelhorn, T. et al. Optimized intravenous Flat Detector CT for non-invasive visualization of intracranial stents: first results. Eur Radiol 21, 411–418 (2011). https://doi.org/10.1007/s00330-010-1931-3
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DOI: https://doi.org/10.1007/s00330-010-1931-3