New approach to quantitative angiographic assessment after stent implantation

The new generation quantitative angiographic systems apply the interpolated technique to calculate the reference diameter at the site of the stenosis by integrating measurements of the segments proximal and distal to the stenosis. After stent implantation these measurements can be misleading as the treated segment, which is frequently larger than the adjacent not stented segments, is included in the measurements. The consequence is an overestimation of the reference diameter and the residual diameter stenosis. The present study was performed to compare this conventional technique of measurement with a new method which excludes the stented segment for the calculation of the reference diameter. Fifty-two lesions treated with poorly radiopaque stents (56% Palmaz-Schatz, 28% NIR, 10% Gianturco-Roubin, 6% Wallstent) expanded at high pressure (≤16 arm) were analyzed according to the conventional and stent excluded method. After stent implantation the reference diameter was 3.39 ± 0.48 mm with conventional measurements and 3.02 ± 0.45 mm with the stent excluded method (P < 0.05). The corresponding % diameter stenosis was 13 ± 9 for the conventional technique and 1 ± 13 for the stent excluded analysis (P < 0.05). The new approach to quantitative coronary analysis after stenting provides higher accuracy in reference diameter calculations and allows a more appropriate matching of stented segments with adjacent normal segments.