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• Confirming the position of stents in adjacent to others with a minimum overlap. Particular dilation guide wire, the Cordis ATW Marker Wire was used. This enabled the treatment with CLEARstend without insertion of a balloon. We can envisage also using this wire with a small-diameter catheter at the time of a diagnostic coronary angiogram procedure. Compared to other systems (e.g. StentBoost), CLEARstent enables improved viewing of the stents with concurrent contrast opacification. This provides better assessment of the flow through stents, particularly collateral ones, and also facilitates fitting endoprostheses in the most difficult cases (left main artery, bifurcational or ostial lesions), thereby avoiding use of costly endovascular imaging instruments (IVUS and OCT) in the majority of cases. Full deployment of the stent was achieved by post-dilation using a 8x4 mm non-compliant high-pressure balloon (20 atm), reaching from the left main artery into the LAD. The result was assessed with CLEARstent using the markers of the non-compliant balloon. The resulting image confirmed full deployment of the stent. We also obtained a clear visualization of the two stent layers within the first few millimetres of the anterior interventricular artery (Fig. 7). At the same time, a contrast injection confirmed excellent flow in the circumflex artery, which allowed us to avoid crushing the new stent in order to open it towards the circumflex artery. The perfect end result was confirmed using conventional angiography (Fig. 8). Six months later, the patient was completely free of angina symptoms. Comments CLEARstent was developed in particular to assess the proper deployment of endocoronary prostheses along with their relation to the vessel wall. As demonstrated in this case, the software can furthermore be used to improve visualization of the artery and its wall or other applications, as in our case: • Viewing the position of stents implanted years earlier, particularly in order to assess the location of any restenosis, • Assessing the extent of calcification of an artery which may be difficult to see in conventional angiography images, • Assisting while positioning an undeployed stent, particularly across ostia of the coronary arteries, or into secondary branches for treatment of bifurcations, CypherStent CypherStent Taxus element 3,5 * 16 Balloon Trek 6 After post-dilatation, CLEARstent Dynamic (A) and Contact hanno.herrmann@siemens.com CLEARstent used for assessment of stent positioning (A) and stent expansion (B) before and after balloon inflation. CLEARstent (B) views confirm the new stent being well apposed to the vessel wall and also show clearly the two layers of stents where overlapping. 7 Final angiography shows satisfying result and confirm good procedure success. 8 NC 4 x 8 mm 2 layers of stents Deployed Taxus element 6A 8A 6B 7A 8B 7B Cardiology CLEARstent 38  AXIOM Innovations | December 2013 | www.siemens.com/angiography


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