This study revealed that stent diameter, post-dilation, extra balloon usage after ‘ClearStent Live’ system (Siemens Healthcare, Munich, Germany) and additional stent deployment by the help of ClearStent implementation associated with better stent expansion which was quantitated by minimal stent diameter.
As conventional angiography-guided PCI relies on two-dimensional projections, assessing the appropriateness of stent placement can be difficult using this method alone. Therefore, there has been compelling requirement of more complex and practical imaging modalities for PCI guidance.
In early 1990’s, Tobis et al. first showed that IVUS, which acquire cross sectional image of coronary arterial wall and get preliminary knowledge about atherosclerotic plaque composition, could be utilized in vivo (14). After IVUS was started to be used widely in clinical practice, follow-up adverse cardiovascular outcomes showed a decreasing trend (15,16). Optical coherence tomography (OCT) is another adjunctive imaging method which provides valuable information about coronary wall cross-sectional structure and atherosclerotic plaque architecture (17). Studies have showed that, similar to IVUS, OCT guided coronary intervention may lead better results than PCI guided by angiography alone (18,19). Although these favorable clinical results of IVUS and OCT, both imaging techniques have some disadvantages. Resolution or penetration challenges, limited tissue characterization, additional contrast media requirement, interpretation difficulties, and cost constitute of some restrictions of these modalities regarding routine clinical use (20).
Enhanced stent imaging techniques such as ClearStent (Siemens Healthcare, Munich, Germany) or StentBoost (Philips Medical Systems Nederland BV, Best, The Netherlands) are novel, software based, motion-compassed imaging techniques that provides enhanced visibility of deployed stent. In addition, this new innovative technology promises a practical and cost-effective clinical use. Emerging clinical studies investigating the impact of ESI to cardiology practice revealed that, ESI guided PCI is associated with lower rates of stent restenosis, target lesion revascularization in follow-up term and major adverse cardiovascular events compared with no use of ESI (21,22). Our study demonstrated that enhanced visualization of deployed coronary stent was associated with better post-interventional result measured as MLD. It can be deduced that ESI guided PCI provides better clinical outcome by means of better visualization of stent characteristics such as deployment status, which help needing for further post-dilation and stent strut fracture assessment (9,22).
Besides its positive contributions, ESI related fluoroscopy time and radiation exposure can be expected to be higher than standard PCI, but the flouroscopy time and radiation exposure of ESI-guided coronary procedures are comparable to that of conventional angiography-guided PCI (22,23). In our study, fluoroscopy time and radiation exposure dose were compatible to the studies in literature (22,23).
Different commercial ESI systems such as StentViz (GE Healthcare), StentBoost (Philips Medical Systems, Netherlands), ClearStent (Siemens Healthcare, Germany), and StentOptimizer (Paieon, Israel) are currently available in market. By virtue of its improved imaging quality, ESI system can be used in different procedural scenarios such as assessing stent under-expansion, stent strut disruption, implantation a second stent in overlap, ostial lesion stenting, bifurcation stenting and side branch preservation (24-27).
Considering the emerging technology, ESI systems promise to be auxiliary tools that can guide the operator in both simple and complex PCI procedures, with features such as cost effectiveness, availability, and procedural and clinically satisfactory results.