Seeing is believing: New technology takes coronary stent visualization to the next level
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Summary
The technologies and tools of the cardiac catheterization lab have evolved in recent years, allowing interventionalists to perform safer procedures with more precision than ever. Angiographic imaging, meanwhile, has remained relatively consistent—but that is all starting to change. In fact, a new generation of intraprocedural imaging is emerging, one that enhances real-time visualization and helps confirm interventions are a success before the patient even leaves the table.
For example, the interventional team at Jefferson Health – Lehigh Valley in Allentown, Pennsylvania, has successfully implemented 3DStent, an advanced coronary stent visualization feature available exclusively on GE HealthCare’s Allia imaging platform. By leveraging cone beam CT (CBCT) technology and proprietary motion compensation software, 3DStent generates interactive 3D reconstructions of deployed stents during PCI. This enables real-time assessments of stent expansion with a level of clarity previously unavailable in the cath lab.
Shailendra Singh, MD, associate director of interventional cardiology at Jefferson Health -Lehigh Valley, was among the early adopters of 3DStent. He and his colleagues perform a high volume of interventional procedures—up to 1,500 PCIs annually—and efficiency and precision are both essential. With a background in biomedical engineering, Singh was particularly interested in exploring how 3DStent could enhance intraprocedural visualization and ultimately contribute to improved patient outcomes.
Challenge
“I’m always driven by the question of how we can make our procedures safer and our outcomes better,” Singh explains. “That’s where my curiosity naturally leads me—and I’m energized when innovation delivers on that promise. 3DStent is one of those rare technologies that can make an immediate impact on both safety and quality. It enhances our confidence during the procedure.”
Adding value without lengthening the procedure
Singh emphasizes that suboptimal coronary stent implantation, including underexpansion and malapposition, can significantly increase the risk of adverse events, including myocardial infarction, stroke or death. These mechanical issues also predispose patients to in-stent restenosis, a well-documented mechanism of late target lesion failure that remains a critical concern in contemporary interventional cardiology.
While stent visualization plays a critical role in helping interventional cardiologists avoid complications during PCI, achieving detailed intraprocedural insight has traditionally required intravascular imaging modalities such as intravascular ultrasound (IVUS) or optical coherence tomography (OCT). Although highly informative, these techniques necessitate additional equipment—namely specialized catheters—and introduce extra steps to acquire and interpret the images. As Singh notes, this can add procedural time and complexity, especially in high-volume settings.
“You’re retrieving the catheter, acquiring the run and then interpreting the images—and that entire sequence is often repeated multiple times,” he explains. “Some cath lab leaders have asked why PCI procedures are taking longer, and in many cases, intravascular imaging is a major factor. It can add a significant amount of time to the workflow, especially if completed multiple times throughout the procedure.”
Using 3DStent, on the other hand, takes less than a minute. The C-arm moves around the patient, the 3D reconstruction appears and the cardiologist is immediately able to evaluate the stent.
“It takes 30 seconds and you’re done,” Singh says. “We know that minimal stent area is the key thing that will tell us whether the PCI was a success, and this gives us that information right away.”
Those data, he adds, can be automatically added to the patient’s electronic health records. This keeps clinicians informed about the procedure and it also can be shown to patients to highlight the improved blood flow in their coronary.
New technology makes an immediate impact
Singh admits to a certain amount of skepticism when he first heard about 3DStent.
“I didn’t fully understand how it could do what it was claiming to do,” he recalls. “But there were no safety concerns—or any major concerns, really—so I was more than happy to try it out.”
What followed was a quick and lasting impression. Singh and his team were immediately struck by how effectively 3DStent helped tell the complete story of each stent they deployed.
“As a fellowship mentor, I always tell younger interventionalists that they need to understand angiography to its core,” he says. “You have to know the views, extract the right data and craft a narrative with your angiograms. 3DStent elevates that process by giving us a 3D perspective we’ve never had before.”
Jefferson Health-Lehigh Valley has been using 3DStent on their Allia IGS 7 for several months now, and the impact has been substantial.
He cites the example of a 73-year-old female with a laundry list of persistent symptoms. She was in bad shape, Singh says, and only getting worse. The team had originally thought she had a bad case of stent failure and required atherectomy. Using 3DStent made it immediately clear, however, that her stent was underexpanded due to some highly calcified plaques. This real-time insight changed their entire treatment approach. Instead of atherectomy with adding another stent, Singh performed intravascular lithotripsy to modify the calcium, followed by expansion using a drug-coated balloon. The minimal stent area increased from 4.2 mm² to 8.4 mm².
“We were really happy with that result,” he says. “We achieved optimal expansion without having to add another layer of metal into the vessel. And she’s doing great, by the way.”
Singh also highlights the added confidence that 3DStent has brought to his team’s practice. Integrating the technology at the end of each PCI has become a valuable part of Lehigh Valley’s workflow, allowing cardiologists to verify stent positioning and detect any issues that may still need to be addressed—before the procedure concludes.
“It’s a really effective way to confirm procedural success,” he says. “Seeing the stent in 3D adds another layer of assurance. You walk away from the case knowing you’ve done everything possible to achieve the best outcome for your patient.”
Looking ahead
Singh believes the potential applications of this technology extend well beyond coronary interventions—and they are only just beginning to be realized.
“Eventually, I see this being used for all interventional procedures involving stents or scaffolds,” he says. “Just recently, I placed a stent in a patient’s leg, and this type of visualization would be incredibly valuable there as well. Intravascular imaging catheters sometimes are not able to be delivered to some of those peripheral vessels, so the ability to generate a 3D view could really transform how we treat those patients.”
Singh also envisions long-term potential for 3DStent in supporting structural heart and endovascular procedures. While widespread use in those areas may still be years away, he’s energized by the possibilities
As interventional cardiology continues to evolve, tools such as 3DStent represent a meaningful leap forward for care teams. They enhance precision, improve outcomes and empower physicians to deliver the highest level of care with greater confidence.
Solutions
Accuracy matters: 3DStent assessments comparable to IVUS
Sponsored by GE HealthCare
3DStent, a new coronary stent visualization feature available on GE HealthCare’s Allia imaging systems, can create an interactive model of a patient’s stent before, during or after a cath lab procedure. This could prove to be a game-changing development for interventional cardiologists—but only if it is accurate.
Carey Kimmelstiel, MD, the director of the interventional cardiology center at Tufts Medicine and a professor at Tufts University School of Medicine, put 3DStent to the test by comparing its accuracy to intravascular ultrasound (IVUS).
Why cardiologists need accurate MSA evaluations
Kimmelstiel and his team evaluated the minimal stent area (MSA) in patients using both 3DStent and IVUS. MSA is the primary measurement used with stent placement, because it offers a complete picture of its effectiveness. They presented the findings at SCAI 2025 Scientific Sessions, the annual meeting of the Society for Cardiovascular Angiography & Interventions.
“When you implant a stent, the size of that stent is going to correlate with outcomes down the road,” Kimmelstiel says. “The bigger the stent area, the better it is for the patient. So MSA is really important to us because it shows us that size and serves as a predictor of post-stent prognosis. Compared to 2D stent enhancement, which only provides users with the stent’s diameter, this is a significant upgrade.”
Carey
Until now, IVUS has been the gold standard in evaluating MSA. But IVUS has still not been widely embraced in modern cath labs, leaving a wide valley between how often it should be used and how often it is used.
“IVUS is underutilized for a lot of reasons,” Kimmelstiel says. “It takes a little more time. It takes expertise that not every interventionalist is going to possess. There also is the issue of cost—IVUS catheters are typically not reimbursed in the United States, forcing the hospital to just eat the cost. And eating the cost is a lot to ask of these health systems right now, especially if it’s something you want to use routinely.”
Cardiologists also evaluate stents using optical coherence tomography (OCT), he adds, but it remains even more underutilized than IVUS; if a cath lab isn’t using IVUS, there’s no reason to expect them to use OCT.
Is there a better way?
The challenges associated with IVUS and OCT implementation created an opportunity. If cardiologists could assess a patient’s MSA without IVUS, it could make a world of difference for the profession as well as for patients.
Kimmelstiel’s group used 3DStent and IVUS on 30 patients, performing side-by-side comparisons of the two technologies. They looked at three different areas of each stent—the proximal and distal stent edges as well as the lesion site—and found that the results were consistently comparable.
“The correlation was extremely high,” Kimmelstiel explains. “We didn’t expect the results to be as good as they were. It really surprised us.”
One of the research team’s biggest takeaways was the lack of interobserver variability. Kimmelstiel and a second interventional cardiologist compared the two modalities while blinded to other patient data as well as each other’s findings. After performing a Pearson correlation coefficient, the group determined that interobserver variability was “really negligible.”
“There was really no variability of note,” he says. “And that’s really important, because it suggests the data should be generalizable to other blinded cardiologists.”
‘No downside’
Bringing new technology into the cath lab typically involves an in-depth look at the advantages and disadvantages. In the case of 3DStent, now that he feels confident in its accuracy, Kimmelstiel says he sees no reason to think twice about using it.
“3DStent is an excellent tool to see how the stent is interacting with the vessel,” he says. “So it makes sense for cath labs to protocolize this into their treatment algorithm. You can gain an enormous amount of information by just taking that final step at the end of the case. And there’s really no downside to doing it.”
By Michael Walter
