Enes ÖZLÜK, Naci KOÇER, Civan IŞLAK, Osman KIZILKILIÇ
Comprehensive Medicine - 2026;18(3):332-338
Objective: Conventional two-dimensional digital subtraction angiography (DSA) may be insufficient for the evaluation of intracranial stents because of overlapping anatomy and device-related artifacts. This study investigated the impact of intraoperative flat-panel detector CT angiography (FP-CTA) on treatment decision-making during intracranial stent procedures. Materials and Methods: In this retrospective, single-center study, 97 patients treated with endovascular stenting between May 2010 and May 2013 were included (78 aneurysms and 19 symptomatic intracranial stenoses). After stent deployment, FP-CTA was obtained to evaluate stent position, expansion, lesion coverage, and vessel patency. Treatment modification was defined as additional stent placement or balloon angioplasty performed solely according to FP-CTA findings. Results: In the aneurysm cohort, FP-CTA prompted treatment modification in 25/78 patients (32%). Eleven patients (14%) required an additional stent because of incomplete neck coverage, malposition, or poor wall apposition. Fourteen patients (18%) underwent balloon angioplasty for underexpansion or residual in-stent stenosis. No FP-CTA-driven modification was required in the stenosis group. No FP-CTA-related complications occurred. Conclusion: Intraoperative FP-CTA frequently changes the treatment strategy, particularly in stent-assisted aneurysm procedures, by detecting suboptimal deployment that is not evident on DSA. It is a useful adjunctive imaging tool for quality control and the optimization of intracranial stent interventions.
