Background: Digital subtraction angiography (DSA) is the gold standard in follow up of endovascular interventions. Photon counting computed tomography (PCCT) represents a technological advancement with significant improvements in image quality including improved spatial resolution and reduced noise when compared to conventional energy integrating detectors. As such PCCT may offer non-invasive alternative to DSA in the follow up of endovascular interventions.
Method: We present a series of 9 cases illustrating the utility of PCCT in following up patients undergoing intracranial MCA and extracranial carotid stenting.
Results: Results are available for 4 patients with ICAD treated with intracranial stenting, and 5 patients with treated extracranial stenting for carotid stenosis who had PCCT imaging performed. All ICAD patients had direct comparison to conventional CTA and MRA. All extracranial stenting patients had conventional CTA comparison available.
PCCT was far superior in detecting stent patency and luminal stenosis. Intimal hyperplasia is demonstrated well on PCCT, where it was largely undetected on conventional CTA and MRI.
[Pertinent images are presented.]
Conclusion: PCCT angiography provides superior imaging quality compared to conventional CTA, in follow up of patients with extracranial and intracranial stenting, enabling accurate characterisation of re-stenosis and intimal hyperplasia without the associated risks of DSA. PCCT angiography may be a safe and reliable alternative to invasive angiography in follow-up of these patients.