Study Shows Utility of Intraoperative Cone Beam CT to Assess Deployed Stents in Endovascular Treatment of Aortoiliac Occlusive Disease

November 2, 2015—A study that evaluated the role of intraoperative cone beam computed tomography (CBCT) to optimize the primary operation results of endovascular treatment of aortoiliac occlusive disease (AIOD) was published by Pelle Törnqvist, MD, et al online ahead of print in the European Journal of Vascular and Endovascular Surgery (EJVES).

In the background of the study, the investigators stated that to maintain long-term patency after endovascular treatment of AIOD, secondary interventions are common. Multiple stents and iliac artery tortuosity often make it difficult to evaluate stent compression intraoperatively and this might be a cause for later failure. Completion angiography (CA) and pressure gradient (PG) measurement are often used to assess the final intraoperative result.

As summarized in EJVES, the prospective study was composed of 53 patients (28 women). All patients underwent endovascular aortoiliac revascularization. Final intraoperative results were evaluated with additional CBCT, after CA and PG were found to be satisfactory. Imaging findings and imaging based adjunctive procedures were recorded.

The investigators reported that 165 stents were placed because of AIOD. Twenty patients underwent adjunctive procedures after the primary stenting. In 24.5% of cases (13 of 53), adjunctive procedures were indicated solely by the CBCT findings, as both standard CA and PG were normal. Twenty-six of the 53 patients had kissing stents placed at the aortic bifurcation. Of the kissing stent patients, 34.6% required adjunctive procedures, and in two thirds of patients these stent compressions were detected only by CBCT.

The use of CBCT revealed a significant number of stent compressions that were not found with CA and PG. When performing endovascular procedures at the aortic bifurcation, CBCT is an excellent intraoperative evaluation method to assess the configuration of deployed stents. In this study, CBCT improved the technical results intraoperatively, which might positively influence the long-term patency, concluded the investigator in EJVES.