Vascular_interview
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Vascular Using DynamicStentView Effectively Tokorozawa Heart Center Masami Sakurada, Director – You have rated the StentView software very highly, but what in kinds of cases is it used normally? While we keep no track of use in a quantitative way, recently we have been using StentView during almost all cases. It is most commonly used when positioning a balloon for stent re-expansion (Fig. 1). One advantage of the StentView software is its ability to display images in real time. When positioning a balloon in very small, one-millimeter increments, cardiac motion always shifts the balloon out of position since it takes time to display images. Images displayed in real time are extremely useful in these situations, as well as in any work involving fine positioning on the millimeter-scale such as positioning a stent so it just overlaps another stent, or when using a stent near the limit of its length (Fig. 2 (a), 2 (b)). StentView also performs image enhancements that clearly show the degree of stent expansion, which allows additional expansion to be used immediately in the event of inadequate expansion (Fig. 3). The real-time display of images is extremely important. Recently, stents have also been becoming thinner and longer. For example, the left coronary artery has a different diameter at its distal and proximal ends, so matching the stent diameter to one end of the artery requires additional pressure adjustments and re-expansions. When performing this kind of procedure, StentView allows positioning the balloon so that it stays inside the stent and identifying Tokorozawa Heart Center has used Shimadzu's FPD-equipped angiography systems since it's founding. As of October 2012, the Tokorozawa Heart Center has two catheterization rooms, performs over 800 PCI procedures per year, and provides 24-hour medical examination and treatment services to the local community. Tokorozawa Heart Center recently introduced DynamicStentView (hereafter StentView), a new PCI support software, and we talked with the director of Tokorozawa Heart Center about how StentView is being used in clinical practice, what they think are the relative advantages of the software (interview conducted in the catheterization room of Tokorozawa Heart Center, October 16, 2012). locations where expansion is poor, thereby replacing the need to use IVUS. This saves on work and reduces procedure times. Fig. 1 Using StentView for stent re-expansion

Using StentView to check the stent edge at the distal end when overlapping the stents at the proximal end Insufficient overlapping confirmed in Fig. 2 (a). Using StentView to check positioning while inserting the balloon a little further – What has changed in terms of PCI procedures before and after introducing StentView? Before we used StentView, I had seen a similar type of software and noticed how it enhanced the stent image, but at the time I thought we could perform fine without it. When I actually started using the StentView and was able to check my progress in real time and position...

– In what other cases do you find StentView useful? With lesions at a flexural area, a catheter gets stuck on an previously placed stent when adding a second stent. The stent can flare or become dislodged (Fig. 5). Some stents are also longitudinally weak. In such cases, using StentView makes procedures safer in that you can observe for deformation of the stent while the procedure is ongoing and adjust your actions moment-by-moment, such as deciding when to stop pushing so hard. You can also quickly acknowledge when to change strategy and pull out. Fig. 5 Using StentView to check a stent...