title: Value of C-Arm Computed Tomography to Evaluate Stent Deployment During Femoro-Popliteal Revascularization.
abstract: OBJECTIVE
  To compare the accuracy of C-arm computed tomography (CT) and digital subtraction angiography (DSA) in detecting incomplete stent expansion (ISE) after superficial femoral artery (SFA) stenting using intravascular ultrasound (IVUS) as a gold standard.
  
  
  METHODS
  Fifty patients with symptomatic SFA occlusive disease requiring angioplasty were prospectively included. Once technical success (<30 % residual stenosis) was obtained on post-procedural DSA, C-arm CT and IVUS were acquired. DSA and C-arm CT examinations were reviewed by 2 investigators and correlated with IVUS. C-arm CT image quality was rated on a four-point scale. Doppler ultrasound was performed at 1-year follow-up.
  
  
  RESULTS
  The ankle-brachial index was 0.69 ± 0.10 and 0.99 ± 0.40, respectively, pre- and post-procedure. C-arm CT imaging quality was rated as good or excellent in 80%. In-stent minimal luminal diameter (MLD) was evaluated at 4.71 ± 0.7 mm on DSA, 3.39 ± 0.6 mm on IVUS, and 3.12 ± 0.9 mm on C-arm CT. Compared to IVUS, DSA demonstrated an overestimation of MLD (p = 0.0001), an underestimation of ISE (DSA = 18.8% ± 7.6; IVUS = 29.8% ± 9) (p < 0.0001), and a poor inter-technique intra-class correlation coefficient (ICC = 0.24). No difference was observed between IVUS and C-arm CT in ISE as calculated by diameter (29.8 ± 9 vs. 28.2 ± 12.5%, p = 0.5) and area (30.2 ± 8.4 vs. 33.3 ± 9.5%, p = 0.2). Inter-technique ICC between C-arm CT and IVUS was 0.72 [95%CI 0.49; 0.85] for MLA measurements. The inter-observer ICC for MLD and MLA measurements on C-arm CT were, respectively, estimated at 0.75 [95% CI 0.40, 0.89] and 0.77 [95% CI 0.43, 0.90)].
  
  
  CONCLUSIONS
  C-arm CT presents a better correlation with IVUS than DSA to determine lumen diameter and ISE immediately after percutaneous revascularization.
authors.affiliation: Centre de Recherche Etienne LeBel, Centre Hospitalier de l'Université de Sherbrooke, Sherbrooke, QC, Canada.
authors.forename: Gerald
authors.initials: G
authors.lastname: Gahide
authors.affiliation: Clinical Image Processing Laboratory (LCTI), Centre de Recherche de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.
authors.forename: Sofiane
authors.initials: S
authors.lastname: Hadjadj
authors.affiliation: Clinical Image Processing Laboratory (LCTI), Centre de Recherche de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.|Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, QC, Canada.|Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), 1560 Sherbrooke Street East, Montreal, QC, H2L 4M1, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Therasse
authors.affiliation: Clinical Image Processing Laboratory (LCTI), Centre de Recherche de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.|Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, QC, Canada.
authors.forename: Claude
authors.initials: C
authors.lastname: Kauffmann
authors.affiliation: Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, QC, Canada.|Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), 1560 Sherbrooke Street East, Montreal, QC, H2L 4M1, Canada.
authors.forename: Patrick
authors.initials: P
authors.lastname: Gilbert
authors.affiliation: Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, QC, Canada.|Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), 1560 Sherbrooke Street East, Montreal, QC, H2L 4M1, Canada.
authors.forename: Vincent L
authors.initials: VL
authors.lastname: Oliva
authors.affiliation: Research Center, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Tardif
authors.affiliation: Research Center, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada.
authors.forename: Jacques
authors.initials: J
authors.lastname: Lespérance
authors.affiliation: Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, QC, Canada.|Laboratory of Biorheology and Medical Ultrasonics, Centre de Recherche de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.|Institute of Biomedical Engineering, University of Montreal, Montreal, QC, Canada.
authors.forename: Guy
authors.initials: G
authors.lastname: Cloutier
authors.affiliation: Clinical Image Processing Laboratory (LCTI), Centre de Recherche de l'Université de Montréal (CRCHUM), Montreal, QC, Canada. gilles.soulez.chum@ssss.gouv.qc.ca.|Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, QC, Canada. gilles.soulez.chum@ssss.gouv.qc.ca.|Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), 1560 Sherbrooke Street East, Montreal, QC, H2L 4M1, Canada. gilles.soulez.chum@ssss.gouv.qc.ca.|Institute of Biomedical Engineering, University of Montreal, Montreal, QC, Canada. gilles.soulez.chum@ssss.gouv.qc.ca.
authors.forename: Gilles
authors.initials: G
authors.lastname: Soulez
mesh_terms: D000368:Aged; D015901:Angiography, Digital Subtraction; D055109:Ankle Brachial Index; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging* / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011150:Popliteal Artery / Q000000981:diagnostic imaging* / Q000601:surgery; D011446:Prospective Studies; D015641:Radiography, Interventional; D015203:Reproducibility of Results; D015607:Stents; D014057:Tomography, X-Ray Computed / Q000379:methods*; D018084:Ultrasonography, Interventional
keywords: Imaging; Peripheral vascular disease; Revascularization