News | November 24, 2010

Rotational CTA Facilitates More Accurate Fenestrated/Branched Stent Placement

November 24, 2010 - Rotational computed tomography angiography (CTA), a new noninvasive imaging modality, has the ability to display angiography in 3-D formats. This allows for considerable simplification of orientation of complex fenestrated/branched stent grafts in 3-D views, as well as catheterization of target vessels. It also enables practitioners to determine whether fenestrated/branched stent grafts are successfully deployed without leaks and thus obviates the need for immediate post-operative CTA.

The plans, constructed using multidetector CTA (MCTA) thin slice images, provide guidance for the final positioning of the fenestrated/branched stent grafts in the aorta. However, especially when the aorta is tortuous, the planned position is often an approximation to the final position achieved. This can considerably increase the technical challenges associated with placement of connecting stents.

Until recently, only 2-D angiographic images have been possible to guide placement of the endograft and connecting stents. In order to overcome this limitation, multiple views from different angles such as from the frontal anterior-posterior to lateral views, have been employed. A large amount of nephrotoxic contrast medium is often used for these repeated 2-D angiographies. Recent developments in angiographic equipment have made possible the acquisition of rotational angiography that gives a 180-degree view of the vascular tree.

“Using this new rotational CTA has proved to be very helpful in determining orientation of fenestrated/branched stent grafts,” said Krassi Ivancev, M.D., professor at the University College of London. “One way to facilitate such orientation in 3-D is to catheterize one or two of the target vessels and then, by using the capabilities of a rotational CTA without contrast medium, making it possible to orient the fenestrated/branched stent grafts accurately using the catheters in the target vessels as reference points.”

“The same technique can be employed for catheterization of target vessels whereupon a limited amount of contrast medium is used selectively only through the catheters in the target vessels, thus reducing the large amount of contrast medium otherwise necessary for routine 2-D angiography/aortogram from differently angled views,” he said.

Ivancev said it is also possible to fuse images from a pre-op MCTA with the images from a rotational CTA, and then to use the fused images for catheterization of the target vessels. In the near future rotational CTA may facilitate selection of an appropriate off-the-shelf fenestrated/branched stent graft based upon 3-D evaluation of the aorta with a large dummy sheath in place to simulate the relative behavior of stent grafts and the target vessels in the presence of tortuosity.

For more information: www.veithpress.org

Related Content

RSNA and ACR to Collaborate on Landmark Medical 3D Printing Registry
News | Medical 3-D Printing | August 08, 2019
The Radiological Society of North America (RSNA) and the American College of Radiology (ACR) will launch a new medical...
Synaptive Medical Launches Modus Plan With Automated Tractography Segmentation
Technology | Neuro Imaging | August 07, 2019
Synaptive Medical announced the U.S. launch and availability of Modus Plan featuring BrightMatter AutoSeg. This release...
Videos | CT Angiography (CTA) | August 07, 2019
This is a quick walk around of the new Siemens Somatom Go.top cardiovascular edition compact computed tomography (CT)
Videos | CT Angiography (CTA) | August 07, 2019
This is a quick walk around of the GE Healthcare Cardiographe dedicated cardiac CT system on display at the...
Artificial Intelligence Improves Heart Attack Risk Assessment
News | CT Angiography (CTA) | August 06, 2019
When used with a common heart scan, machine learning, a type of artificial intelligence (AI), does better than...
An example of FFR-CT imaging from Beaumont Hospital in Royal Oak, Mich. The left image shows a 3D generated image of the coronary tree from a CT scan evaluated with computational fluid dynamics to determine the FFR numbers. It shows a severe restriction of the left main artery which requires a stent to revacularize. The image on the right is a comparison with the invasive angiogram from the cath lab prior to stenting.

An example of FFR-CT imaging from Beaumont Hospital in Royal Oak, Mich. The left image shows a 3D generated image of the coronary tree from a CT scan evaluated with computational fluid dynamics to determine the FFR numbers. It shows a severe restriction of the left main artery which requires a stent to revacularize. The image on the right is a comparison with the invasive angiogram from the cath lab prior to stenting. 

Feature | Cardiac Imaging | July 24, 2019 | Greg Freiherr
One of the big trends in cardiac computed tomography (CT) imaging has been the introduction of noninvasive...