Ahmet Barış DURUKAN, Hakan GÖÇER, Osman TUNÇ, Erdinç NASER, Ertuğrul ERCAN

Karotis arter stent planlamasında 3D baskılı anatomik karotis modellerin değerlendirilmesi

Amaç: Bu çalışmada üç boyutlu baskılı anatomik modellerin işlem öncesi planlanan, uygulama ve karotis arter stent ve emboli önleme cihazının boyut ve yerleşiminin belirlenmesindeki muhtemel rolü araştırıldı. Çalışma planı: Ocak 2017 - Şubat 2019 tarihleri arasında emboli önleme cihazı ile karotis arter stentleme yapılan toplam 16 hasta (10 erkek, 6 kadın; ort. yaş 75.6±4.7 yıl; dağılım, 68-81 yıl) retrospektif olarak incelendi. Boyut, distal önleme cihazı kullanılarak aynı marka stent ile işlem sırası yapılan anjiyografi sonuçlarına göre belirlendi. Tanıda kullanılan işlem öncesi bilgisayarlı tomografi anjiyografi görüntüleri elde edildi ve üç boyutlu baskı yöntemi ile modellendi. Stent ve önleme cihazlarının boyutu ve implantasyon bölgelerine ilişkin işlem öncesi ve üç boyutlu veriler karşılaştırıldı. Bulgular: Stent ve emboli önleme cihazı boyutları, manuel üç boyutlu modelden ve yazılımdan segmentasyon görüntülerinden elde edilen ölçümler için benzer ve asıl kullanılanlardan küçük idi. Karotis arter darlığı oranı da, manuel ve yazılım yöntemler ile benzerdi; ancak, kantitatif anjiyografik ölçümlere kıyasla daha düşük idi. Manuel ve yazılım modelleri ile tespit edilen cihaz implantasyon yerleri, gerçekte kullanılandan farklı idi. Sonuç: Üç boyutlu modeller ile işlemin planlanması ve uygulanması, operatöre bağımlı değişkenleri azaltabilir, ameliyat zamanını kısaltabilir, radyasyon maruziyetini düşürebilir ve işlem başarısını artırabilir.

Evaluation of 3D printed carotid anatomical models in planning carotid artery stenting

Background: We aimed to investigate the potential role of threedimensional printed anatomical models in pre-procedural planning,practice, and selection of carotid artery stent and embolic protectiondevice size and location.Methods: A total of 16 patients (10 males, 6 females; mean age75.6±4.7 years; range, 68 to 81 years) who underwent carotid arterystenting with an embolic protection device between January 2017 andFebruary 2019 were retrospectively analyzed. The sizing was basedon intraprocedural angiography findings with the same brand stentusing distal protection device. Pre-procedural computed tomographyangiography images used for diagnosis were obtained and modeledwith three-dimensional printing method. Pre-procedural and threedimensional data regarding the size of stents and protection devicesand implantation sites were compared.Results: Measurements obtained from three-dimensional modelsmanually and segmentation images from software were found tobe similar and both were smaller than actually used for stent andembolic protection device sizes. The rates of carotid artery stenosiswere similar with manual and software methods, but were lower thanthe quantitative angiographic measurements. Device implantationsites detected by the manual and software methods were differentthan the actual setting.Conclusion: The planning and practicing of procedure with threedimensional models may reduce the operator-dependent variables,shorten the operation time, decrease X-ray exposure, and increasethe procedural success.

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