Intraoperative Diagnostic Methods for Superior Mesenteric Artery Stenting in Chronic Mesenteric Ischemia

Area of Science:

• Interventional Radiology
• Vascular Surgery
• Medical Imaging

Background:

• Chronic mesenteric ischemia (CMI) is often caused by superior mesenteric artery (SMA) stenosis.
• Endovascular therapy (EVT) is an effective treatment for CMI.
• Accurate intraoperative assessment is vital for successful SMA stenting and long-term patency.

Purpose of the Study:

• To evaluate intra-arterial pressure measurement (IAPM) and cone beam computed tomography (CBCT) for detecting residual stenosis during SMA stenting in CMI patients.
• To compare the efficacy of IAPM and CBCT against digital subtraction angiography (DSA) in assessing residual stenosis.

Main Methods:

• A prospective study of 50 consecutive patients with symptomatic SMA stenosis undergoing elective EVT.
• Intraoperative assessment using DSA, IAPM, and CBCT after stent placement.
• Technical success defined by <30% residual stenosis on DSA, <10 mmHg gradient with IAPM, and full stent expansion on CBCT.

Main Results:

• DSA showed fair agreement with CBCT (Kappa=0.294) but tended to under-detect residual stenosis compared to CBCT (OR=0.176).
• DSA significantly differed from IAPM (Kappa=0.016), suggesting under-detection of residual stenosis (>10 mmHg).
• CBCT and IAPM showed comparable results (Kappa=0.201), indicating similar detection of residual stenosis.

Conclusions:

• Digital subtraction angiography (DSA) may overlook significant residual stenosis after SMA stenting.
• Cone beam computed tomography (CBCT) provides valuable structural assessment of stents.
• IAPM and CBCT are more sensitive than DSA for detecting residual stenosis, aiding on-table procedural optimization.