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Coronary stent and stent-graft selection: Could 3D printing be the answer to getting the perfect fit?

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  • Pre-operative planning
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After a blocked artery has been treated with angioplasty to restore blood flow, the artery may become blocked again. One way to prevent this from reoccurring is to place a stent inside the artery at the spot where the blockage was cleared by angioplasty. - SecondsCount

Typically, a coronary stent can cost between $11,000-$41,000. And, choosing the wrong sized stent at the planning stage can be a costly and timely affair, with lasting negative outcomes for patients.

According to a recent study published on the BMJ, placing a larger stent can induce more trauma to vessels and therefore more intimal hyperplasia, more edge dissections, and more coronary ruptures. Conversely, under expanded stents increase both the risk of restenosis and the likelihood of stent thrombosis.

Aneurysms can develop in any blood vessel in the body, but the two most common places are the artery that transports blood away from the heart to the rest of the body (the abdominal aorta) and the brain. As blood passes through the weakened blood vessel, the blood pressure causes a small area to bulge outwards like a balloon.

In this study of 40 patients published in the Journal of Endovascular Therapy, using CTA imaging alone, stent-graft sizes significantly changed on the basis of the measurement method and device; for example, using the outer diameter to size a stent-graft that requires an inner diameter reference changed 36% of the selected stent-graft sizes, with ∼20% being excessively oversized. Conversely, using the inner diameter to size an outer-diameter–based stent-graft resulted in nearly 40% of the sizes being altered. Based on dynamic measurements, the changes were more dramatic: the oversizing was considered excessive in up to 90% of patients if the measurement method did not match the stent-graft's stipulated reference.

Could 3D printing be the answer to getting the perfect fit?

A recent study published in Quantitative Imaging in Medicine and Surgery, simulating stent placement in 3D printed arteries, shows that when a 3D printed model was used, optimal placement into the right and left coronary arteries was reported in 100% of cases. By using a patient-specific 3D printed model in planning for coronary stent placement, you can gain the additional insight needed to ensure a perfect fit.

Axial3D creates patient-specific, 1:1 3D printed anatomical models that transform how surgeons interact with patient data and provide the accuracy needed to test stent placement well ahead of stepping into the operating theater. This not only potentially saves thousands of dollars, but also ensures the best patient outcomes in any complex case.

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