Application of High-Resolution Flat Detector Computed Tomography in Stent Implantation for Intracranial Atherosclerotic Stenosis

Tengfei Li; Yuting Wang; Ji Ma; Michael Levitt; Mahmud Mossa-Basha; Chengcheng Shi; Yuncai Ran; Jianzhuang Ren; Xinwei Han; Chengcheng Zhu

doi:10.3389/fnins.2021.655594

Application of High-Resolution Flat Detector Computed Tomography in Stent Implantation for Intracranial Atherosclerotic Stenosis

Front Neurosci. 2021 Aug 27:15:655594. doi: 10.3389/fnins.2021.655594. eCollection 2021.

Authors

Tengfei Li^{1

2}, Yuting Wang³, Ji Ma^{1

2}, Michael Levitt⁴, Mahmud Mossa-Basha⁵, Chengcheng Shi^{1

2}, Yuncai Ran⁶, Jianzhuang Ren^{1

2}, Xinwei Han^{1

2}, Chengcheng Zhu⁵

Affiliations

¹ Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
² Interventional Institute of Zhengzhou University, Zhengzhou, China.
³ Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
⁴ Department of Neurological Surgery, University of Washington, Seattle, WA, United States.
⁵ Department of Radiology, University of Washington, Seattle, WA, United States.
⁶ Department of Magnetic Resonance, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.

Abstract

Objective: To evaluate the utility of high-resolution flat-detector computed tomography (HR-FDCT) compared with conventional flat-detector computed tomography (FDCT) for stent placement in symptomatic intracranial atherosclerotic stenosis (ICAS).

Methods: We retrospectively reviewed the clinical data of 116 patients with symptomatic ICAS who underwent stent implantation. Images were acquired using conventional FDCT [voxel size = 0.43 mm (isotropic)] and HR-FDCT [voxel size = 0.15 mm (isotropic)]. Immediately after stent deployment, dual-volume three-dimensional (3D) fusion images were obtained from 3D digital subtraction angiography (DSA) and HR-FDCT. The image quality for stent visualization was graded from 0 to 2 (0: not able to assess; 1: limited, but able to assess; 2: clear visualization), and the stent-expansion status ("full," "under-expanded" or "poor apposition") was recorded.

Results: A total of 116 patients with symptomatic ICAS were treated successfully using 116 stents (58 Neuroform^TM EZ, 42 Enterprise^TM, and 16 Apollo^TM). The mean pre-stent stenosis was 80.5 ± 6.4%, which improved to 20.8 ± 6.9% after stenting. Compared with FDCT, HR-FDCT improved visualization of the fine structures of the stent to improve the image quality that significantly (mean score: 1.63 ± 0.60 vs. 0.41 ± 0.59, P < 0.001). In 19 patients, stent under-expansion (n = 11) or poor apposition (n = 8) was identified by HR-FDCT but not by conventional FDCT. After balloon dilatation, stent malapposition was shown to have improved on HR-FDCT. None of the 19 patients with stent malapposition experienced short-term complications during hospitalization or had in-stent stenosis at 6-month follow-up.

Conclusion: High-resolution flat-detector computed tomography (HR-FDCT) improves visualization of the fine structures of intracranial stents deployed for symptomatic ICAS compared with that visualized using conventional FDCT. High-resolution flat-detector computed tomography improves assessment of stent deployment and could reduce the risk of complications.

Keywords: complications; flat detector CT; intracranial atherosclerosis; stenosis; stent.