Intraoperative Diagnostic Methods for Superior Mesenteric Artery Stenting in Chronic Mesenteric Ischemia.

Background/

Objectives

Chronic mesenteric ischemia (CMI) due to superior mesenteric artery (SMA) stenosis can be effectively treated with endovascular therapy (EVT). Appropriate intraoperative assessment is crucial for ensuring technical success and long-term patency. This study assesses intra-arterial pressure measurement (IAPM), and cone beam computed tomography (CBCT) for detecting residual stenosis during SMA stenting in CMI.

Methods

This prospective study included 50 consecutive elective patients with symptomatic, significant SMA stenosis scheduled for EVT. The patients in this study were a subset of an ongoing randomized trial with a different primary objective. Intraoperative diagnostic tools-digital subtraction angiography (DSA), IAPM and CBCT were performed after stent placement. Technical success was defined as <30% residual stenosis on DSA, a residual pressure gradient of <10 mmHg with IAPM and full stent expansion on CBCT.

Results

Although there was a fair agreement between DSA and CBCT (Kappa 0.294, p = 0.024), the Odds ratio suggests that DSA detected fewer positive cases compared to CBCT (Odds ratio 0.176; 95% CI: 0.004-1.37; p = 0.13). DSA also differed significantly from IAPM (Kappa = 0.016, p = 0.882), (Odds ratio = 0.167; 95% CI: 0.018-0.749; p = 0.013), suggesting DSA under-detects residual stenosis (>10 mmHg). No significant difference was found between CBCT and IAPM (Kappa = 0.201, p = 0.161) (Odds ratio: 2.25, 95% CI: 0.628-10.0%; p = 0.27) indicating comparable results.

Conclusions

DSA overlooks clinically important residual stenosis that could be treated during the primary procedure. CBCT aids structural assessment of the stent and allows for on-table optimizing of the procedural outcomes.