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

Background/Objectives: Chronic mesenteric ischemia (CMI) due to superior mesenteric artery (SMA) stenosis can be effectively treated with endovascular therapy (EVT). Appropriate intraoperative assessment is crucial for ensuring technical success and long-term patency. This study assesses intra-arterial pressure measurement (IAPM), and cone beam computed tomography (CBCT) for detecting residual stenosis during SMA stenting in CMI. Methods: This prospective study included 50 consecutive elective patients with symptomatic, significant SMA stenosis scheduled for EVT. The patients in this study were a subset of an ongoing randomized trial with a different primary objective. Intraoperative diagnostic tools-digital subtraction angiography (DSA), IAPM and CBCT were performed after stent placement. Technical success was defined as <30% residual stenosis on DSA, a residual pressure gradient of <10 mmHg with IAPM and full stent expansion on CBCT. Results: Although there was a fair agreement between DSA and CBCT (Kappa 0.294, p = 0.024), the Odds ratio suggests that DSA detected fewer positive cases compared to CBCT (Odds ratio 0.176; 95% CI: 0.004-1.37; p = 0.13). DSA also differed significantly from IAPM (Kappa = 0.016, p = 0.882), (Odds ratio = 0.167; 95% CI: 0.018-0.749; p = 0.013), suggesting DSA under-detects residual stenosis (>10 mmHg). No significant difference was found between CBCT and IAPM (Kappa = 0.201, p = 0.161) (Odds ratio: 2.25, 95% CI: 0.628-10.0%; p = 0.27) indicating comparable results. Conclusions: DSA overlooks clinically important residual stenosis that could be treated during the primary procedure. CBCT aids structural assessment of the stent and allows for on-table optimizing of the procedural outcomes.