NAEOTOM Alpha - Clinical Case Video: Coronary Stents

Let's talk about a 71 year old male patient. He's got a history of coronary stenting and he came to the hospital for a regular check up. He had four stents put in. They were placed in the left main artery, the proximal and middle parts of the left anterior descending artery, and also in the circumflex artery. A coronary CT angiography was performed. An ultra high resolution skin mode was used which is called Quantum HD Cardiac. The goal was to check the patency of those coronary stents and also see how much plaque burden there was. Now when we looked at the Quantum HD images, we saw that there were three stents that were connected. One was in the LM and the proximal LED and it was 4mm in diameter. Then there were two stents in the middle. LA D1 was 3mm and the other was 2.75mm. All of these stents were open and there was no sign of instant restenosis or ISR. That's great news. But then we saw another single stent in the proximal CX, which was 3.5mm in diameter. In the middle part of this stent, there were signs of intimal hyperplasia that caused the lumen to narrow, but it was less than 50%. We also saw multiple calcified plaques in different places. There were some in the proximal and distal CX, in the second obtuse marginal branch and in the right coronary artery, the RCA. And in the mid RCA there were two mixed plaques. All these plaques caused mild stenosis. Based on the CT findings, we classified it as CAD RATS 2S. We ruled out coronary ISR because remember, ISR is when there's a re narrowing of more than 50% in the previously stent arterial lumen and that would require revascularization. And since this patient wasn't showing any symptoms, we didn't think we needed to do any further invasive tests. Coronary ISR is something that we come across a lot. It happens because of factors related to the stent itself, the procedure of putting the stent in, and also biological factors. To figure out what's causing ISR and to guide how we manage it clinically, we've used things like intra coronary imaging that includes angiography, intravascular ultrasound or IVUS, and optical coherence tomography, or Oct. Now, when it comes to using CCTA to check the patency of coronary stents, the American Heart Association guidelines say that with conventional energy integrating detector CT, we're limited to stents with a diameter of 3mm. That's because of the problem with blooming artifacts caused by the stent struts. But there's been some improvement with the introduction of this quantum HD scan mode on the dual source photon counting CT neotom alpha. In a photon counting CT, instead of separating detector pixels physically like in an Eid, we use an electric field to define smaller detector subpixels. These subpixels are read out separately and that increases the spatial resolution while still keeping the geometrical dose efficiency. In the NEATOM alpha. We can get quantum HD data at a temporal resolution of 66 milliseconds. A recent study using this mode had a 100% negative predictive value for evaluating coronary stent patency when compared to invasive angiography, which is the reference standard in this case. When we looked at the UHR images, which were 0.2mm with a kernel of BV72, we could clearly see that the hypodense intimal hyperplasia was causing less than 50% narrowing of the lumen. So we ruled out ISR. But if we reconstructed the images at 0.6mm with a kernel of BV 48, which is like a standard image reconstruction in CCTA with an EIDCT, we might have diagnosed an ISR and that would have meant we'd need to do further invasive tests. The combination of high spatial and temporal resolution that the photon counting CT provides helps. It improves how well we can see the coronary stents and it reduces the interference from blooming caused by calcified plaques and stent struts. And that helps us doctors make a confident assessment of whether the stents are open and also make the right decision about how to manage the patient.

002303872 562 1724 2.5 600 200 7/18/2024 120 00 12 172 56 /18/2024 724 2. 768 15 1936 550 NAEOTOM Alpha Clinical case video: Coronary stents SIEMENS . Alpha CoronaryCTA_Stent_HD CTA Coronary 0 20 Bv72 Q4 BestDiast 78% thin LAD SP L35.0 SP A223.3 5cm MPR LAO 90 59bpm, 78% D, 66ms HRP SP A905.5 CX RCA_2 RFA MPR CV Manip C VRT SL min CAUD 90 CRAN 26 2025/04/10 12:15:48 SP L9.2 SP A203.5 . SP H1690.2 RC CX 2 Healthineers L min D 3 LAO 3 IL 10:40:24 AM RCA 2 LAD 3 KV 12 Eff. mAs 38 Bv72.4 P +78% BestDiast M 768x768 Skip CTA Coronary 0.20 Bv72 Q4 BestDiast 78% thin +C KV 120 HR 62 BPM 59bpm, 78% D. 66ms SP A1004.5 RCA LAO 8 ARH LAO 77 AHR LAO 94 SP H1154.4 ARF SC LAO 43 SP L1197.3 LAO 60 SL min SP A195.5 SP A209.1 SP A206.2 SP A196.1 SP A183.9 SP A170.3 CTA Coronary 0 20 Bv72 Q4'BestDiast 78% thin IF SP H1325.9 LAO 39 Bv72 4 SP L777.7 AHL LAO 124 SP L1062.3 SP H1440.3 RAF LAO 35 HPR LAO 37 SP L47.3 SP A151.6 SP H1290.5 LAO 53 SP L125.7 ALH LAO 102 SP R29.4 SP A152.1 59bpm, 79% D, 66ms SP R21.7 SP A178.8 SP A157.5 SP H1711 5 LA RA LAO 33 SP R25.4 PR RAO 74 LAD_3 10.0 mm SL m +5.0 mm 0:40:24 AM P +79% BestDiast SIEMENS MPF CTA Coronary 0 20 Bv72 Q4 BestDiast 78% thin . LAD5cm LL HPL CRAN 13 SP A598.8 AL LAO 116 SP L60.4 SP L54.3 SP A147.0 SP L47.0 SP A151.9 5.0 mm SP H1783.8 Distance Line Marker Set Marker at Position Exclude this Volume SP H1763.4 A: 52 % = 15.1 mm 14 9 mm = 30.0 mm CTA Coronary 0.60 Bv48 Q4 BestDiast 79% P +79% BestDast V 120 P +78% BestDas Hagar MT, Soschynski M, Saffar R, et al. Ultra-high-resolution photon-counting detector CT in evaluating coronary stent patency: a comparison to invasive coronary angiography. Eur Radiol. 2024; doi: 10.1007/s00330-023-10516-3. LAO 118 SP L450.8 SP A1049.7 P +78% BestDast SP L826.0 LAO 93 SP L629.6 HRA Series Series Name CTA Coronary 0.60 Bv48 Q ... +7.5 mm 15 0 mm = 15.0 mm SP H1763.2 D 41 % D 2 1/2 7 mm 3.8 mm -15.0 mm SP A152.2 SP H1763.8 CRAN 24 kV 12 Please note that the learning material is for training purposes only. For the proper use of the software or hardware, please always use the Operator Manual or Instructions for Use (hereinafter collectively "Operator Manual") issued by Siemens Healthineers. This material is to be used as training material only and shall by no means substitute the Operator Manual. Any material used in this training will not be updated on a regular basis and does not necessarily reflect the latest version of the software and hardware available at the time of the training. The Operator Manual shall be used as your main reference, in particular for relevant safety information like warnings and cautions. Please note: Some functions shown in this material are optional and might not be part of your system. Certain products, product related claims or functionalities (hereinafter collectively "Functionality") may not (yet) be commercially available in your country. Due to regulatory requirements, the future availability of said Functionalities in any specific country is not guaranteed. Please contact your local Siemens Healthineers sales representative for the most current information. The statements by Siemens Healthineers' customers described herein are based on results that were achieved in the customer's unique setting. Because there is no "typical" hospital or laboratory and many variables exist (e.g ., hospital size, samples mix, case mix, level of IT and/or automation adoption) there can be no guarantee that other customers will achieve the same results. Page 1 of 2 The reproduction, transmission, or distribution of this training or its contents is not permitted without express written authority. Offenders will be liable for damages. All names and data of patients, parameters, and configuration dependent designations are fictional and examples only. means substitute the All rights, including rights created by patent grant or registration of a utility model or design, are reserved. Unrestricted | Published by Siemens Healthineers AG |CSiemens Healthineers AG, 2025ty information like warnings and cautions. Siemens Healthineers HQ I Siemens Healthineers AG Siemensstr. 3 91301 Forchheim Germany Phone: +49 9191 18-0 siemens-healthineers.com Unrestricted | Published by Siemens Healthineers AG | @ Siemens Healthineers AG, 2025