Interoperator and Intraoperator (In)accuracy of Stent Selection Based on Visual Estimation

Catheter Cardiovasc Interv. 2015 Dec 1;86(7):1177-83. doi: 10.1002/ccd.25780. Epub 2015 Jan 23.


Objectives: The objectives of this study were to evaluate the ability of interventional cardiologists to accurately measure lesion length and select appropriate stents.

Background: Inaccurate measurement of lesion length during percutaneous coronary intervention (PCI) increases the risk of restenosis.

Methods: Interventional cardiologists (n = 40) evaluated 25 matched orthogonal angiographic images that were prescored using quantitative coronary angiography (QCA) by a core laboratory. Visual estimates of lesion length and stent length selection were compared to the maximum QCA value. A 2-4 mm stent overlap of both the proximal and distal lesion edges was considered to be optimal. Based on optimal stent overlap, accurate lesion lengths were those measured from -1 to +4 mm from the QCA. Likewise, appropriate stent lengths were those that measured between +4 mm to +8 mm from the QCA value. Five images were repeated to assess intrarater variability.

Results: Lesion length measurements were short and long for 51.1% (95% CI 47.6-54.6%) and 19.0% (95% CI 16.3-21.9%) of the images, respectively. Stent length selections that were short and long were recorded for 55.0% (95% CI 51.5-58.5%) and 22.8% (95% CI 19.9-25.8%) of the images, respectively. Intrarater variability evaluation indicated that 38.5% (95% CI 31.7-45.6%) of lesion length measurements and 37.5% (95% CI 30.8-44.6%) of stent length selections were >3 mm different between the first and second evaluation of repeated images.

Conclusions: Visual estimation of coronary lesion length has a high degree of variability, which may lead to inappropriate stent selection. Improving the accuracy of lesion length measurement may improve patient outcomes.

Keywords: lesion length; percutaneous coronary intervention; quantitative coronary angiography.

MeSH terms

  • Adult
  • Aged
  • Clinical Competence
  • Coronary Angiography*
  • Coronary Artery Disease / diagnostic imaging
  • Coronary Artery Disease / therapy*
  • Coronary Vessels / diagnostic imaging*
  • Humans
  • Judgment
  • Middle Aged
  • Observer Variation
  • Percutaneous Coronary Intervention / instrumentation*
  • Predictive Value of Tests
  • Prospective Studies
  • Prosthesis Design
  • Reproducibility of Results
  • Stents*
  • Visual Perception*