0:01

A word or two about stents.

0:03

Stents are difficult, stents are easier

0:06

now that they're thinner.

0:07

Um, but we know that stents, uh, also imply

0:10

that there's a high risk of coronary disease.

0:12

And I like this picture from the Cadrad 2.0 guideline

0:15

document because it shows the challenge of stents.

0:18

In addition to the metal, you place a stent

0:21

for coronary disease, which can be heavily calcified.

0:23

And so the image on the right side

0:25

of your screen shows you very dense calcium

0:28

outside of the stent.

0:30

And that dense calcium is the enemy of ct,

0:32

whether there's a stent or not.

0:33

So it's adding difficulty to an already difficult case.

0:36

For that reason, we have a modifier on this cadra grading

0:41

that discloses that there's a stent present.

0:43

Um, just like we do for cabbage, we add a G for graft,

0:46

for stents, we add an S

0:47

and that should tell the viewer of the report

0:49

that we know we have some limitations.

0:51

Newer scanners get better and better,

0:53

but you really wanna focus on excellent

0:55

exquisite image quality.

0:56

You need thin cuts, sharp kernels, motion free images,

0:59

good contrast bolus.

1:01

And what you see here is a instant re-stenosis.

1:04

And it's actually difficult

1:05

to say the precise degree of stenosis.

1:08

However, the scan does show here

1:11

that there's something significant and you can see

1:12

because there's all the normal contrast bolus

1:15

otherwise intervening.

1:17

Um, the other thing is when you see a stent is to be careful

1:19

that you look beyond the stent

1:21

because what can be a cause

1:23

of stent failure is under treatment

1:25

and the invasive angiography may not realize

1:27

that there's plaque that they didn't treat

1:29

because it didn't cause much

1:30

narrowing on the day of the stent.

1:31

So if you see a stent at the very least,

1:34

clarify whether you can see in it at all.

1:36

If there's bad artifacts, just say that.

1:38

Um, and if you look beyond the stent

1:40

and see native disease, that's an important thing to say.

1:43

Native stenosis beyond the stent

1:45

or native ados, sclerosis beyond the stent.

1:47

Um, if you can, uh, try to make an assessment

1:49

that the luminous patent

1:51

and if you're able to look for stent fractures

1:54

or any other kind of malpositioning.