First-in-man study of coronary stent 3D reconstruction in the cathlab using rotational angiography

Stent under-expansion is a well-known predictor of post-percutaneous coronary intervention (PCI) major adverse cardiovascular events (MACE). This article presents a new technique to image coronary stents in 3D in the cathlab utilizing only the angiographic equipment.

Thirty patients with an indication of PCI were consented and prospectively included. They underwent a 3D rotational angiography following stent deployment without contrast injection. The 3D reconstructions of the coronary stents were independently reviewed offline by three experienced interventional cardiologists. Image quality was assessed using a qualitative scale: Excellent (struts are highly contrasted and sharp), Good (struts are contrasted enough to be distinguished from the background), Fair (the overall shape of the stent can be assessed but the precise demarcation between struts and background may be ambiguous in some areas) or Limited (it is challenging to distinguish the struts from the background). The 3D stent reconstruction quality was evaluated as Excellent for 37.8% of the cases, Good for 33.3%, Fair for 22.2%, and Limited for 6.7%. Substantial to near-perfect agreement was observed among reviewers (weighted Cohen's kappa 0.8, 0.78, 0.82 for the three pairs of reviewers respectively). The 3D quality was significantly correlated with the BMI using the Spearman rank correlation coefficient (ρ=0.74, P-value < 0.001).

The study demonstrates that 3D rotational angiography is feasible during PCI. The 3D reconstructions were evaluated as excellent or good in most patients by three interventional cardiologists. Additional studies are necessary to validate the measurements with respect to intra-vascular imaging and evaluate the role of this new technique in stent optimization.