New imaging technique could improve stenting of bifurcations lesions


A study published in EuroIntervention indicates that StentBoost (Philips), which is a novel fluoroscopic imaging technique, could be used to enhance stent visibility during percutaneous coronary intervention (PCI) procedures in patients with bifurcation lesions. 

Joana Silva (Cardiovascular Intervention Unit, Cardiology Department, University Hospital Germans Trials i Pujol, Barcelona, Spain) and others commented that StentBoost was a novel imaging technique that enhanced stent visibility. They reported: “Through motion-corrected acquisition frames, an enhanced picture of the stent and its relation with the vessel wall is obtained.” They explained that the technique might be useful during PCI for bifurcation lesions because rewiring a side branch could be challenging with coronary angiography (the gold standard for evaluating and classifying of coronary stenoses), because stent structure visualisation was difficult after implantation. The authors noted: “The purpose of this study is to evaluate the improvement of stent visibility obtained with StentBoost and to summarise the potential role of this new imaging tool during bifurcation PCI.  

In the single-centre, prospective study, Silva et al assessed imaging data from consecutive patients with angiographic evidence of a significant bifurcation lesion and a clinical indication for PCI who underwent complex bifurcation angioplasty with the use of StentBoost. They wrote that StentBoost was used when fluoroscopic images were insufficient to guide bifurcation PCI, and the main uses of StentBoost in the study were to obtain the stent expansion ratio after stent deployment, to provide guidance during side branch rewiring, aid stent positioning in a two-stent strategy, and to help positioning the balloons for post dilation and kissing balloon technique.

According to the authors, in the 97 patients who underwent angioplasty with StentBoost, StentBoost image quality was “generally good”. They reported: “In 79.6% of the cases, an optimal visualisation of the stent struts and guidewire was obtained; 19.4% had a suboptimal visualisation and 1% had poor visualisation.” Silva et al added that in three cases, StentBoost “enabled the identification of the guidewire and angioplasty balloon passing outside stent borders during rewiring of the side branch, allowing for their repositioning and trajectory confirmation.”

The advantages of StentBoost, Silva et al reported, are that it does not require the insertion of additional devices into the coronary arteries, does not involve specific training of the operator or staff, and does not increase radiation exposure or procedure time. They concluded: “Our results indicate that this technique can provide valuable information through several stages of the procedure (visualisation of guidewire, balloon and stent, strut opening at the side branch ostium, balloon and stent positioning, need for post dilation) and avoid periprocedural complications.” They added: “StentBoost allows for adequate ostium visualisation and is particularly sensitive to detect severe stent disortion.”