Development of an Educational Application of Multimodal Imaging of Clinically Implanted and Bifurcation Stenting Procedures

Background: Today, the implantation of stents is the most common procedure to treat coronary artery disease and reopen occluded vessels. It is difficult to fully comprehend the procedures and outcomes of complex techniques such as bifurcation stenting. Here, we describe the development of an educational application that includes anatomic tutorials, multimodal imaging of hundreds of performed complex procedures, outcomes of clinically implanted procedures, and step-by-step imaging of bifurcation procedures. Methods: Bifurcation procedures were performed within reanimated large mammalian hearts and formalin-fixed human hearts. The procedures performed in reanimated hearts and clinically implanted stents from cadaveric hearts were imaged using an endoscope, fluoroscopy, and optical coherence tomography, and the final implant was micro computed tomography scanned. The mobile app was developed to visualize the resulting 3D models in augmented reality, and additional imaging was also added. Results: The application successfully allows the user to view the outcomes of both clinically implanted stents and bifurcation procedures and associate these outcomes with clinical imaging. Additionally, clinical imaging including fluoroscopy and optical coherence tomography were available in conjunction with endoscope videos to integrate the 3D views with the images that would be acquired during a typical clinical case. Conclusions: As this mobile app is open-access, the educational opportunities for direct visualizations of stent implantations can be expanded to those who cannot personally utilize the Visible Heart Laboratories. The provided observations and studies of these procedures should aid everyone, from students to experts, with important insights into the implantation of stents that can improve their understanding and clinical practice.