title: Enhanced stent imaging improves the diagnosis of stent underexpansion and optimizes stent deployment.
abstract: OBJECTIVE
  To investigate the clinical value and diagnostic accuracy of enhanced stent imaging (ESI) as compared with quantitative coronary angiography (QCA) and intravascular ultrasound (IVUS).
  
  
  BACKGROUND
  ESI is an image acquisition and processing angiography-based software that improves visualization and provides measurements of deployed stents.
  
  
  METHODS
  A total of 40 consecutive patients (42 stents) were studied. Stent deployment was evaluated sequentially and independently by angiography, ESI, and IVUS. Following each imaging modality, the operator determined the necessity of postdilation unrelated to the other modalities. Stent diameters were measured off-line by QCA, ESI, and IVUS at several sites along the deployed stent and compared.
  
  
  RESULTS
  Following stent deployment and based solely on angiography, the operator decided to postdilate seven of the 42 stents (16.7%). This decision was not changed after reviewing the ESI images of these seven stents. Of the 35 stents not requiring postdilation based on angiography alone, ESI influenced the operator to change the decision and postdilate 10 of 35 stents (28.6%). The ESI-based measurements had better correlation with IVUS (r = 0.721, P < 0.0001) than did QCA with IVUS (r = 0.563, P < 0.0001). Bland-Altman analysis showed a trend towards better agreement between ESI and IVUS than between QCA and IVUS (mean differences = 0.038 vs. 0.121; P = 0.19, respectively).
  
  
  CONCLUSIONS
  ESI is an easy to use modality that enhances stent visualization, helps in the decision making process whether to postdilate the stent, and provides estimation of stent expansion with better correlations than QCA when compared to IVUS. © 2012 Wiley Periodicals, Inc.
authors.affiliation: Columbia University Medical Center, New York, NY, USA.
authors.forename: Elias A
authors.initials: EA
authors.lastname: Sanidas
authors.forename: Akiko
authors.initials: A
authors.lastname: Maehara
authors.forename: Ravit
authors.initials: R
authors.lastname: Barkama
authors.forename: Gary S
authors.initials: GS
authors.lastname: Mintz
authors.forename: Varinder
authors.initials: V
authors.lastname: Singh
authors.forename: Ariel
authors.initials: A
authors.lastname: Hidalgo
authors.forename: Diaa
authors.initials: D
authors.lastname: Hakim
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Moses
authors.forename: Giora
authors.initials: G
authors.lastname: Weisz
mesh_terms: D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D015203:Reproducibility of Results; D015607:Stents; D018084:Ultrasonography, Interventional / Q000379:methods*