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Evaluation of endothelialization of an occluder device with cardiac computed tomography and assessment of the
Ang Liu1, Xuejing Duan2, Ke Wang1
1Department of Structural Heart Disease, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Insights
Contrast uptake in occlusive devices on cardiac computed tomography angiography (CTA) indicates incomplete endothelialization. This finding was confirmed by pathology, suggesting late device endothelialization is common.
Area of Science:
- Cardiovascular Imaging
- Medical Device Technology
- Pathology
Background:
- Noninvasive assessment of occlusive device endothelialization is challenging.
- Cardiac computed tomography angiography (CTA) offers potential for evaluating device endothelialization via contrast uptake.
Purpose of the Study:
- To examine device endothelialization using cardiac CTA.
- To investigate pathological associations with cardiac CTA findings.
Main Methods:
- Retrospective analysis of 25 patients undergoing surgical device removal after cardiac CTA.
- Assessment of contrast uptake within occlusive devices using cardiac CTA.
- Correlation of contrast uptake with pathological endothelialization status.
Main Results:
- 76% of patients showed contrast uptake within the occluder, correlating with incomplete endothelialization (no or partial coverage).
- Devices without contrast uptake showed complete fibrotic tissue coverage but incomplete neoendothelium in 66.67% of cases.
- Devices implanted >6 months frequently exhibited incomplete coverage on both discs.
Conclusions:
- Cardiac CTA contrast uptake is a reliable indicator of incomplete device endothelialization.
- Late endothelialization of occlusive devices is a frequent occurrence.
- Further research is needed to understand the mechanisms of late endothelialization.
Background:
Assessing the endothelialization of occlusive devices noninvasively remains a challenge. Cardiac computed tomography angiography (CTA) can be employed to evaluate device endothelialization based on contrast uptake within the occluder.
Objective:
This study examined device endothelialization using cardiac CTA and investigated the pathological associations.
Methods:
From January 2010 to May 2022, we retrospectively analyzed 25 patients (age: 50.00 [17.00, 52.00] years; 12 Female) who underwent surgical device removal within 1 month after cardiac CTA examination (implantation period: 29.00[0.50, 108.00] months). The contrast uptake within the occluder was determined using cardiac CTA. The relationship between contrast uptake within the occluder and the endothelialization status with pathology was analyzed.
Results:
Contrast uptake within the occluder was identified in 76.00% of patients. Pathological examination confirmed incomplete coverage of fibrotic tissue and superposed neoendothelium on the surface of all devices exhibiting contrast uptake. This included no coverage in 47.37% of patients and partial coverage in the remaining cases. On the surface of all devices without contrast uptake, a complete range of fibrotic tissue was observed, with an incomplete range of superposed neoendothelium in 66.67% of patients. On the surface of devices with an implantation period > 6 months, 71.43% of patients had incomplete coverage of fibrotic tissue and superposed neoendothelium on the left disc, 42.86% of patients occurred the same on the right disc.
Conclusions:
Contrast uptake within the occluder indicated incomplete endothelialization, as confirmed by pathological validation. Late endothelialization of the device occurs frequently, and further research is required to investigate related mechanisms.
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