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Kurogi K, Tokai T, Shirahama Y, Yamamoto N, Serikawa T, Ishii M, Tsujita K. Real-Time Intravascular Ultrasound Guidance Versus Angiographic Guidance for Precise Left Anterior Descending Artery Ostial Stenting. Am J Cardiol 2024; 226:36-39. [PMID: 38972533 DOI: 10.1016/j.amjcard.2024.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Revised: 06/26/2024] [Accepted: 06/27/2024] [Indexed: 07/09/2024]
Affiliation(s)
- Kazumasa Kurogi
- Department of Cardiovascular Medicine, Miyazaki Prefectural Nobeoka Hospital, Miyazaki, Japan
| | - Tatsuya Tokai
- Department of Cardiovascular Medicine, Miyazaki Prefectural Nobeoka Hospital, Miyazaki, Japan
| | - Yuichiro Shirahama
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Nobuyasu Yamamoto
- Department of Cardiovascular Medicine, Miyazaki Prefectural Nobeoka Hospital, Miyazaki, Japan
| | - Takeshi Serikawa
- Department of Cardiovascular Medicine, Fukuoka Wajiro Hospital, Fukuoka, Japan
| | - Masanobu Ishii
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
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2
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Rinfret S, Verreault-Julien L, Croce K. The Balloon-Assisted Double-Kissing T-Stenting Technique: Concept, In Vitro Model, and Case Examples. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2024; 3:101928. [PMID: 39132000 PMCID: PMC11307903 DOI: 10.1016/j.jscai.2024.101928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/09/2024] [Accepted: 03/01/2024] [Indexed: 08/13/2024]
Abstract
Background In complex bifurcation percutaneous coronary intervention, 2-stent strategies are often required. Commonly used 2-stent techniques can lead to suboptimal results due to their complexity. We developed the balloon-assisted double-kissing T-stenting (DKT) technique, which uses balloons to optimize stent placement, delivery, and final architecture. Methods With the balloon-assisted DKT technique, a balloon is inflated into the main branch (MB) to identify the best position of the side-branch (SB) stent instead of relying on angiography. DKT aims at supporting the SB ostium with stent crowns instead of distorted open cell(s), by achieving a longitudinal deformation with minimal crush of the SB stent upon implantation of the MB stent. This hypothesis was tested on a bench model. We report how the technique was performed in 2 cases and provide intracoronary imaging of the results. Results As hypothesized, DKT resulted in a longitudinal accordion-like deformation and minimal crush effect on bench. The SB ostium was supported by stent crowns. The SB wall opposed to the carina was well covered with crowns from the MB stent after proximal optimization technique and final kissing. The technique was successfully used in 2 complex left main cases with perfect coverage of the SB ostium as assessed with intracoronary imaging. Conclusions The balloon-assisted DKT is a simple technique that combines strengths of double-kissing crush and culotte techniques, results in appropriate SB ostium coverage, and deserves further investigation.
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Affiliation(s)
- Stéphane Rinfret
- Department of Cardiology, Emory Heart and Vascular, Emory University, Atlanta, Georgia
| | | | - Kevin Croce
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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3
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Kotoku N, Ninomiya K, Ding D, O'Leary N, Tobe A, Miyashita K, Masuda S, Kageyama S, Garg S, Leipsic JA, Mushtaq S, Andreini D, Tanaka K, de Mey J, Wijns W, Tu S, Piazza N, Onuma Y, Serruys PW. Murray law-based quantitative flow ratio to assess left main bifurcation stenosis: selecting the angiographic projection matters. Int J Cardiovasc Imaging 2024; 40:195-206. [PMID: 37870715 PMCID: PMC10774209 DOI: 10.1007/s10554-023-02974-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/25/2023] [Indexed: 10/24/2023]
Abstract
Murray law-based quantitative flow ratio (µQFR) assesses fractional flow reserve (FFR) in bifurcation lesions using a single angiographic view, enhancing the feasibility of analysis; however, accuracy may be compromised in suboptimal angiographic projections. FFRCT is a well-validated non-invasive method measuring FFR from coronary computed tomographic angiography (CCTA). We evaluated the feasibility of µQFR in left main (LM) bifurcations, the impact of the optimal/suboptimal fluoroscopic view with respect to CCTA, and its diagnostic concordance with FFRCT. In 300 patients with three-vessel disease, the values of FFRCT and µQFR were compared at distal LM, proximal left anterior descending artery (pLAD) and circumflex artery (pLCX). The optimal viewing angle of LM bifurcation was defined on CCTA by 3-dimensional coordinates and converted into a 2-dimensional fluoroscopic view. The best fluoroscopic projection was considered the closest angulation to the optimal viewing angle on CCTA. µQFR was successfully computed in 805 projections. In the best projections, µQFR sensitivity was 88.2% (95% CI 76.1-95.6) and 84.8% (71.1-93.7), and specificity was 96.8% (93.8-98.6) and 97.2% (94.4-98.9), in pLAD and pLCX, respectively, with regard to FFRCT. The AUC of µQFR for predicting FFRCT ≤ 0.80 tended to be improved using the best versus suboptimal projections (0.94 vs. 0.89 [p = 0.048] in pLAD; 0.94 vs. 0.88 [p = 0.075] in pLCX). Computation of µQFR in LM bifurcations using a single angiographic view showed high feasibility from post-hoc analysis of coronary angiograms obtained for clinical purposes. The fluoroscopic viewing angle influences the diagnostic performance of physiological assessment using a single angiographic view.
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Affiliation(s)
- Nozomi Kotoku
- Department of Cardiology, University of Galway, University Road, Galway, H91 TK33, Ireland
| | - Kai Ninomiya
- Department of Cardiology, University of Galway, University Road, Galway, H91 TK33, Ireland
| | - Daixin Ding
- The Lambe Institute for Translational Medicine, The Smart Sensors Laboratory and CURAM, University of Galway, Galway, Ireland
| | - Neil O'Leary
- Department of Cardiology, University of Galway, University Road, Galway, H91 TK33, Ireland
| | - Akihiro Tobe
- Department of Cardiology, University of Galway, University Road, Galway, H91 TK33, Ireland
| | - Kotaro Miyashita
- Department of Cardiology, University of Galway, University Road, Galway, H91 TK33, Ireland
| | - Shinichiro Masuda
- Department of Cardiology, University of Galway, University Road, Galway, H91 TK33, Ireland
| | - Shigetaka Kageyama
- Department of Cardiology, University of Galway, University Road, Galway, H91 TK33, Ireland
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, UK
| | - Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Saima Mushtaq
- Departments of Cardiovascular Imaging and Surgery, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Daniele Andreini
- Division of Cardiology and Cardiac Imaging, IRCCS Galeazzi Sant'Ambrogio, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Kaoru Tanaka
- Department of Radiology, Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium
| | - Johan de Mey
- Department of Radiology, Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium
| | - William Wijns
- The Lambe Institute for Translational Medicine, The Smart Sensors Laboratory and CURAM, University of Galway, Galway, Ireland
| | - Shengxian Tu
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Nicolo Piazza
- Department of Medicine, Division of Cardiology, McGill University Health Center, Montreal, QC, Canada
| | - Yoshinobu Onuma
- Department of Cardiology, University of Galway, University Road, Galway, H91 TK33, Ireland
| | - Patrick W Serruys
- Department of Cardiology, University of Galway, University Road, Galway, H91 TK33, Ireland.
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4
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Barbato E, Gallinoro E, Abdel-Wahab M, Andreini D, Carrié D, Di Mario C, Dudek D, Escaned J, Fajadet J, Guagliumi G, Hill J, McEntegart M, Mashayekhi K, Mezilis N, Onuma Y, Reczuch K, Shlofmitz R, Stefanini G, Tarantini G, Toth GG, Vaquerizo B, Wijns W, Ribichini FL. Management strategies for heavily calcified coronary stenoses: an EAPCI clinical consensus statement in collaboration with the EURO4C-PCR group. Eur Heart J 2023; 44:4340-4356. [PMID: 37208199 DOI: 10.1093/eurheartj/ehad342] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 05/14/2023] [Accepted: 05/16/2023] [Indexed: 05/21/2023] Open
Abstract
Since the publication of the 2015 EAPCI consensus on rotational atherectomy, the number of percutaneous coronary interventions (PCI) performed in patients with severely calcified coronary artery disease has grown substantially. This has been prompted on one side by the clinical demand for the continuous increase in life expectancy, the sustained expansion of the primary PCI networks worldwide, and the routine performance of revascularization procedures in elderly patients; on the other side, the availability of new and dedicated technologies such as orbital atherectomy and intravascular lithotripsy, as well as the optimization of the rotational atherectomy system, has increased operators' confidence in attempting more challenging PCI. This current EAPCI clinical consensus statement prepared in collaboration with the EURO4C-PCR group describes the comprehensive management of patients with heavily calcified coronary stenoses, starting with how to use non-invasive and invasive imaging to assess calcium burden and inform procedural planning. Objective and practical guidance is provided on the selection of the optimal interventional tool and technique based on the specific calcium morphology and anatomic location. Finally, the specific clinical implications of treating these patients are considered, including the prevention and management of complications and the importance of adequate training and education.
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Affiliation(s)
- Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University, Via di Grottarossa n. 1035, Rome, 00189, Italy
| | - Emanuele Gallinoro
- Division of University Cardiology, IRCCS Galeazzi-Sant'Ambrogio Hospital, University of Milan, Milan, Italy
| | | | - Daniele Andreini
- Division of University Cardiology, IRCCS Galeazzi-Sant'Ambrogio Hospital, University of Milan, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Didier Carrié
- Service de Cardiologie B, CHU Rangueil, Université Paul Sabatier, Toulouse, France
| | - Carlo Di Mario
- Interventional Structural Cardiology Division, Department of Clinical & Experimental Medicine, Careggi University Hospital, Florence, Italy
| | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Javier Escaned
- Hospital Clínico San Carlos IDISCC, Complutense University of Madrid, Madrid, Spain
| | | | | | - Jonathan Hill
- Department of Cardiology, Royal Brompton Hospital, London, UK
| | - Margaret McEntegart
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Kambis Mashayekhi
- Department of Internal Medicine and Cardiology, MediClin Heart Institute Lahr/Baden, Lahr & Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | | | - Yoshinobu Onuma
- Department of Cardiology, Cardiovascular Center, Fujita Health University Hospital, Toyoake, Japan
- Department of Cardiology, National University of Ireland, Galway, Ireland
| | - Krzyszstof Reczuch
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | | | - Giulio Stefanini
- Humanitas Clinical and Research Hospital IRCCS & Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Gabor G Toth
- University Heart Center Graz, Medical University of Graz, Graz, Austria
| | - Beatriz Vaquerizo
- Unidad de Cardiología Intervencionista, Hospital del Mar, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - William Wijns
- The Lambe Institute for Translational Medicine, The Smart Sensors Laboratory, Corrib Core Laboratory and Curam, National University of Ireland, Galway, Ireland
| | - Flavio L Ribichini
- Cardiovascular Section of the Department of Medicine, University of Verona, Verona, Italy
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5
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Koo BK, Lee JM, Hwang D, Park S, Shiono Y, Yonetsu T, Lee SH, Kawase Y, Ahn JM, Matsuo H, Shin ES, Hu X, Ding D, Fezzi S, Tu S, Low AF, Kubo T, Nam CW, Yong AS, Harding SA, Xu B, Hur SH, Choo GH, Tan HC, Mullasari A, Hsieh IC, Kakuta T, Akasaka T, Wang J, Tahk SJ, Fearon WF, Escaned J, Park SJ. Practical Application of Coronary Physiologic Assessment: Asia-Pacific Expert Consensus Document: Part 1. JACC. ASIA 2023; 3:689-706. [PMID: 38095005 PMCID: PMC10715899 DOI: 10.1016/j.jacasi.2023.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/13/2023] [Accepted: 07/08/2023] [Indexed: 12/30/2023]
Abstract
Coronary physiologic assessment is performed to measure coronary pressure, flow, and resistance or their surrogates to enable the selection of appropriate management strategy and its optimization for patients with coronary artery disease. The value of physiologic assessment is supported by a large body of evidence that has led to major recommendations in clinical practice guidelines. This expert consensus document aims to convey practical and balanced recommendations and future perspectives for coronary physiologic assessment for physicians and patients in the Asia-Pacific region based on updated information in the field that including both wire- and image-based physiologic assessment. This is Part 1 of the whole consensus document, which describes the general concept of coronary physiology, as well as practical information on the clinical application of physiologic indices and novel image-based physiologic assessment.
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Affiliation(s)
- Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Doyeon Hwang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Sungjoon Park
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Taishi Yonetsu
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Seung Hun Lee
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Yoshiaki Kawase
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - Jung-Min Ahn
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Xinyang Hu
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Daixin Ding
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- The Lambe Institute for Translational Medicine, The Smart Sensors Lab and Curam, National University of Ireland, University Road, Galway, Ireland
| | - Simone Fezzi
- The Lambe Institute for Translational Medicine, The Smart Sensors Lab and Curam, National University of Ireland, University Road, Galway, Ireland
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Adrian F. Low
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; National University Heart Centre, National University Health System, Singapore
| | - Takashi Kubo
- Department of Cardiology, Tokyo Medical University, Hachioji Medical Center, Tokyo, Japan
| | - Chang-Wook Nam
- Department of Internal Medicine and Cardiovascular Research Institute, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Andy S.C. Yong
- Department of Cardiology, Concord Hospital, University of Sydney, Sydney, Australia
| | - Scott A. Harding
- Department of Cardiology, Wellington Hospital, Wellington, New Zealand
| | - Bo Xu
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Seung-Ho Hur
- Department of Internal Medicine and Cardiovascular Research Institute, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Gim Hooi Choo
- Department of Cardiology, Cardiac Vascular Sentral KL (CVSKL), Kuala Lumpur, Malaysia
| | - Huay Cheem Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; National University Heart Centre, National University Health System, Singapore
| | - Ajit Mullasari
- Department of Cardiology, Madras Medical Mission, Chennai, India
| | - I-Chang Hsieh
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Tsunekazu Kakuta
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Jian'an Wang
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Seung-Jea Tahk
- Department of Cardiology, Ajou University Medical Center, Suwon, Korea
| | - William F. Fearon
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Javier Escaned
- Hospital Clinico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain
| | - Seung-Jung Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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6
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Pellegrini D, Ielasi A, Tespili M, Guagliumi G, De Luca G. Percutaneous Treatment of Left Main Disease: A Review of Current Status. J Clin Med 2023; 12:4972. [PMID: 37568374 PMCID: PMC10419939 DOI: 10.3390/jcm12154972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 07/13/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
Percutaneous treatment of the left main coronary artery is one of the most challenging scenarios in interventional cardiology, due to the large portion of myocardium at risk the technical complexity of treating a complex bifurcation with large branches. Our aim is to provide un updated overview of the current indications for percutaneous treatment of the left main, the different techniques and the rationale underlying the choice for provisional versus upfront two-stent strategies, intravascular imaging and physiology guidance in the management of left main disease, and the role of mechanical support devices in complex high-risk PCI.
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Affiliation(s)
- Dario Pellegrini
- Division of Cardiology, IRCCS Ospedale Galeazzi-Sant’Ambrogio, Via Cristina Belgioioso, 173, 20161 Milan, Italy; (D.P.)
| | - Alfonso Ielasi
- Division of Cardiology, IRCCS Ospedale Galeazzi-Sant’Ambrogio, Via Cristina Belgioioso, 173, 20161 Milan, Italy; (D.P.)
| | - Maurizio Tespili
- Division of Cardiology, IRCCS Ospedale Galeazzi-Sant’Ambrogio, Via Cristina Belgioioso, 173, 20161 Milan, Italy; (D.P.)
| | - Giulio Guagliumi
- Division of Cardiology, IRCCS Ospedale Galeazzi-Sant’Ambrogio, Via Cristina Belgioioso, 173, 20161 Milan, Italy; (D.P.)
| | - Giuseppe De Luca
- Division of Cardiology, IRCCS Ospedale Galeazzi-Sant’Ambrogio, Via Cristina Belgioioso, 173, 20161 Milan, Italy; (D.P.)
- Division of Cardiology, AOU “Policlinico G. Martino”, Via Consolare Valeria, 1, 98124 Messina, Italy
- Department of Clinical and Experimental Medicine, University of Messina, Piazza Pugliatti, 1, 98122 Messina, Italy
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7
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Serruys PW, Kotoku N, Nørgaard BL, Garg S, Nieman K, Dweck MR, Bax JJ, Knuuti J, Narula J, Perera D, Taylor CA, Leipsic JA, Nicol ED, Piazza N, Schultz CJ, Kitagawa K, Bruyne BD, Collet C, Tanaka K, Mushtaq S, Belmonte M, Dudek D, Zlahoda-Huzior A, Tu S, Wijns W, Sharif F, Budoff MJ, Mey JD, Andreini D, Onuma Y. Computed tomographic angiography in coronary artery disease. EUROINTERVENTION 2023; 18:e1307-e1327. [PMID: 37025086 PMCID: PMC10071125 DOI: 10.4244/eij-d-22-00776] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 11/14/2022] [Indexed: 04/05/2023]
Abstract
Coronary computed tomographic angiography (CCTA) is becoming the first-line investigation for establishing the presence of coronary artery disease and, with fractional flow reserve (FFRCT), its haemodynamic significance. In patients without significant epicardial obstruction, its role is either to rule out atherosclerosis or to detect subclinical plaque that should be monitored for plaque progression/regression following prevention therapy and provide risk classification. Ischaemic non-obstructive coronary arteries are also expected to be assessed by non-invasive imaging, including CCTA. In patients with significant epicardial obstruction, CCTA can assist in planning revascularisation by determining the disease complexity, vessel size, lesion length and tissue composition of the atherosclerotic plaque, as well as the best fluoroscopic viewing angle; it may also help in selecting adjunctive percutaneous devices (e.g., rotational atherectomy) and in determining the best landing zone for stents or bypass grafts.
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Affiliation(s)
| | - Nozomi Kotoku
- Department of Cardiology, University of Galway, Galway, Ireland
| | - Bjarne L Nørgaard
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, UK
| | - Koen Nieman
- Department of Radiology and Division of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Marc R Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Juhani Knuuti
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | | | - Divaka Perera
- School of Cardiovascular Medicine and Sciences, British Heart Foundation Centre of Research Excellence, King's College London, London, UK
| | | | - Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Edward D Nicol
- Royal Brompton Hospital, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Nicolo Piazza
- Department of Medicine, Division of Cardiology, McGill University Health Center, Montreal, Quebec, Canada
| | - Carl J Schultz
- Division of Internal Medicine, Medical School, University of Western Australia, Perth, WA, Australia
- Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia
| | - Kakuya Kitagawa
- Department of Advanced Diagnostic Imaging, Mie University Graduate School of Medicine, Mie, Japan
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
- Department of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Kaoru Tanaka
- Department of Radiology, Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium
| | | | | | - Darius Dudek
- Szpital Uniwersytecki w Krakowie, Krakow, Poland
| | - Adriana Zlahoda-Huzior
- Digital Innovations & Robotics Hub, Krakow, Poland
- Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland
| | - Shengxian Tu
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - William Wijns
- Department of Cardiology, University of Galway, Galway, Ireland
- The Lambe Institute for Translational Medicine, The Smart Sensors Laboratory and CURAM, Galway, University of Galway, Galway, Ireland
| | - Faisal Sharif
- Department of Cardiology, University of Galway, Galway, Ireland
| | - Matthew J Budoff
- Division of Cardiology, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Johan de Mey
- Department of Radiology, Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium
| | - Daniele Andreini
- Division of Cardiology and Cardiac Imaging, IRCCS Galeazzi Sant'Ambrogio, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Yoshinobu Onuma
- Department of Cardiology, University of Galway, Galway, Ireland
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8
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Medina de Chazal HA, Zgheib A, Al Isma'ili A, Martucci G, Spaziano M, Piazza N. The Role of CT-Guided Optimal Fluoroscopic Viewing Angle for Coronary Engagement After TAVR. JACC Case Rep 2023; 9:101742. [PMID: 36909270 PMCID: PMC9998712 DOI: 10.1016/j.jaccas.2023.101742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 12/12/2022] [Indexed: 01/31/2023]
Abstract
We report the case of an 89-year-old woman with prior transcatheter aortic valve replacement who underwent successful left coronary artery engagement and left circumflex percutaneous coronary intervention using patient-specific computed tomography fluoroscopic projections. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Horacio A Medina de Chazal
- Division of Cardiology, Department of Medicine, McGill University Health Center, Glen Hospital, Montreal, Quebec, Canada
| | - Ali Zgheib
- Division of Cardiology, Department of Medicine, McGill University Health Center, Glen Hospital, Montreal, Quebec, Canada
| | - Abdullah Al Isma'ili
- Division of Cardiology, Department of Medicine, McGill University Health Center, Glen Hospital, Montreal, Quebec, Canada
| | - Giuseppe Martucci
- Division of Cardiology, Department of Medicine, McGill University Health Center, Glen Hospital, Montreal, Quebec, Canada
| | - Marco Spaziano
- Division of Cardiology, Department of Medicine, McGill University Health Center, Glen Hospital, Montreal, Quebec, Canada
| | - Nicolo Piazza
- Division of Cardiology, Department of Medicine, McGill University Health Center, Glen Hospital, Montreal, Quebec, Canada
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9
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Zgheib A, Campens L, Abualsaud A, Al Isma'ili A, Barbanti M, Dvir D, Gada H, Granada JF, Latib A, Leipsic J, Maisano F, Martucci G, Medina de Chazal HA, Modine T, Mylotte D, Prendergast B, Sawaya F, Spaziano M, Tang G, Theriault-Lauzier P, Tchetche D, van Mieghem N, Søndergaard L, De Backer O, Piazza N. Aortic Annulus S-Curve: Implications for Transcatheter Aortic Valve Replacement and Related Procedures, Part 1. JACC Cardiovasc Interv 2022; 15:2353-2373. [PMID: 36480983 DOI: 10.1016/j.jcin.2022.08.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/18/2022]
Abstract
Most transcatheter aortic valve replacement-related procedures (eg, transcatheter aortic valve replacement implantation depth, commissural alignment, coronary access, bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction, paravalvular leak closure) require an optimal fluoroscopic viewing angle located somewhere along the aortic annulus S-curve. Chamber views, coronary cusp and coronary anatomy, can be understood along the aortic annulus S-curve. A better understanding of the optimal fluoroscopic viewing angles along the S-curve may translate into increased operator confidence and improved safety and efficacy while reducing procedural time, radiation dose, contrast volume, and complication rates.
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Affiliation(s)
- Ali Zgheib
- McGill University Health Center, Glen Hospital, Department of Medicine, Division of Cardiology, Montreal, Quebec, Canada
| | - Laurence Campens
- Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Ali Abualsaud
- Department of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Abdullah Al Isma'ili
- McGill University Health Center, Glen Hospital, Department of Medicine, Division of Cardiology, Montreal, Quebec, Canada
| | - Marco Barbanti
- A.O.U. Policlinico Vittorio Emanuele, University of Catania, Catania, Italy
| | - Danny Dvir
- Jesselson Integrated Heart Center, Department of Cardiology, Shaare Zedek Medical Centre, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hemal Gada
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Juan F Granada
- Cardiovascular Research Foundation, New York, New York, USA
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Jonathon Leipsic
- Centres for Heart Valve and Cardiovascular Innovation, St. Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Giuseppe Martucci
- McGill University Health Center, Glen Hospital, Department of Medicine, Division of Cardiology, Montreal, Quebec, Canada
| | - Horacio A Medina de Chazal
- McGill University Health Center, Glen Hospital, Department of Medicine, Division of Cardiology, Montreal, Quebec, Canada
| | - Thomas Modine
- UMCV, Hôpital Haut Lévêque, CHU de Bordeaux, Pessac, France
| | - Darren Mylotte
- Department of Cardiology, Galway University Hospital, and National University of Ireland Galway, Galway, Ireland
| | - Bernard Prendergast
- Department of Cardiology, Cleveland Clinic and Saint Thomas' Hospitals, London, United Kingdom
| | - Fadi Sawaya
- Department of Medicine, Division of Cardiology, American University of Beirut, Beirut, Lebanon
| | - Marco Spaziano
- McGill University Health Center, Glen Hospital, Department of Medicine, Division of Cardiology, Montreal, Quebec, Canada
| | - Gilbert Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, New York, USA
| | - Pascal Theriault-Lauzier
- Departments of Medicine (Cardiology and Nuclear Medicine) and Radiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | - Nicolas van Mieghem
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Lars Søndergaard
- Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Ole De Backer
- Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Nicolo Piazza
- McGill University Health Center, Glen Hospital, Department of Medicine, Division of Cardiology, Montreal, Quebec, Canada.
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10
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Andreini D, Collet C, Leipsic J, Nieman K, Bittencurt M, De Mey J, Buls N, Onuma Y, Mushtaq S, Conte E, Bartorelli AL, Stefanini G, Sonck J, Knaapen P, Ghoshhajra B, Serruys PW. Pre-procedural planning of coronary revascularization by cardiac computed tomography: An expert consensus document of the Society of Cardiovascular Computed Tomography. EUROINTERVENTION 2022; 18:e872-e887. [PMID: 35994043 PMCID: PMC9743242 DOI: 10.4244/eij-e-22-00036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/05/2022] [Indexed: 12/12/2022]
Abstract
Coronary CT angiography (CCTA) demonstrated high diagnostic accuracy for detecting coronary artery disease (CAD) and a key role in the management of patients with low-to-intermediate pretest likelihood of CAD. However, the clinical information provided by this noninvasive method is still regarded insufficient in patients with diffuse and complex CAD and for planning percutaneous coronary intervention (PCI) and surgical revascularization procedures. On the other hand, technology advancements have recently shown to improve CCTA diagnostic accuracy in patients with diffuse and calcific stenoses. Moreover, stress CT myocardial perfusion imaging (CT-MPI) and fractional flow reserve derived from CCTA (CT-FFR) have been introduced in clinical practice as new tools for evaluating the functional relevance of coronary stenoses, with the possibility to overcome the main CCTA drawback, i.e. anatomical assessment only. The potential value of CCTA to plan and guide interventional procedures lies in the wide range of information it can provide: a) detailed evaluation of plaque extension, volume and composition; b) prediction of procedural success of CTO PCI using scores derived from CCTA; c) identification of coronary lesions requiring additional techniques (e.g., atherectomy and lithotripsy) to improve stent implantation success by assessing calcium score and calcific plaque distribution; d) assessment of CCTA-derived Syntax Score and Syntax Score II, which allows to select the mode of revascularization (PCI or CABG) in patients with complex and multivessel CAD. The aim of this Consensus Document is to review and discuss the available data supporting the role of CCTA, CT-FFR and stress CT-MPI in the preprocedural and possibly intraprocedural planning and guidance of myocardial revascularization interventions.
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Affiliation(s)
- Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | | | - Jonathon Leipsic
- St Paul's Hospital & University of British Columbia, Vancouver, British Columbia Vancouver, Canada
| | - Koen Nieman
- Stanford University School of Medicine, Departments of Medicine and Radiology, USA
| | - Marcio Bittencurt
- Division of Internal Medicine, University Hospital, University of São Paulo, São Paulo, Brazil
- DASA, São Paulo, Brazil
- Division of Cardiology and the Heart and Vascular Institute, University of Pittsburgh Medical Center
| | - Johan De Mey
- Department of Radiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussel, Belgium
| | - Nico Buls
- Department of Radiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussel, Belgium
| | - Yoshinobu Onuma
- Clinical Science Institute, National University of Ireland, Galway, Ireland
| | | | - Edoardo Conte
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
- Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLVZ Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy
| | - Paul Knaapen
- Vrije Universiteit Medical Center, Amsterdam, Netherlands
| | - Brian Ghoshhajra
- Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Patrick W Serruys
- Clinical Science Institute, National University of Ireland, Galway, Ireland
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11
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Baig I, Lee AJ, Brinkman W, Gopal A, Dasi LP, Al-Azizi K. Simultaneous Kissing Balloon Inflation of the Transcatheter Aortic Valve Replacement Valve and an Ostial Coronary Stent-A Novel Coronary Protection Technique. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2022; 6:100074. [PMID: 37288126 PMCID: PMC10242579 DOI: 10.1016/j.shj.2022.100074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/21/2022] [Accepted: 06/27/2022] [Indexed: 06/09/2023]
Affiliation(s)
- Imran Baig
- Baylor Scott & White Health The Heart Hospital - Plano, Plano, Texas, USA
| | - Arthur J. Lee
- Baylor Scott & White Health The Heart Hospital - Plano, Plano, Texas, USA
| | - William Brinkman
- Baylor Scott & White Health The Heart Hospital - Plano, Plano, Texas, USA
| | - Ambarish Gopal
- Baylor Scott & White Health The Heart Hospital - Plano, Plano, Texas, USA
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA
| | - Karim Al-Azizi
- Baylor Scott & White Health The Heart Hospital - Plano, Plano, Texas, USA
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12
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Andreini D, Collet C, Leipsic J, Nieman K, Bittencurt M, De Mey J, Buls N, Onuma Y, Mushtaq S, Conte E, Bartorelli AL, Stefanini G, Sonck J, Knaapen P, Ghoshhajra B, Serruys P. Pre-procedural planning of coronary revascularization by cardiac computed tomography: An expert consensus document of the Society of Cardiovascular Computed Tomography. J Cardiovasc Comput Tomogr 2022; 16:558-572. [PMID: 36008263 DOI: 10.1016/j.jcct.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 06/07/2022] [Accepted: 08/05/2022] [Indexed: 10/15/2022]
Abstract
Coronary CT angiography (CCTA) demonstrated high diagnostic accuracy for detecting coronary artery disease (CAD) and a key role in the management of patients with low-to-intermediate pretest likelihood of CAD. However, the clinical information provided by this noninvasive method is still regarded insufficient in patients with diffuse and complex CAD and for planning percutaneous coronary intervention (PCI) and surgical revascularization procedures. On the other hand, technology advancements have recently shown to improve CCTA diagnostic accuracy in patients with diffuse and calcific stenoses. Moreover, stress CT myocardial perfusion imaging (CT-MPI) and fractional flow reserve derived from CCTA (CT-FFR) have been introduced in clinical practice as new tools for evaluating the functional relevance of coronary stenoses, with the possibility to overcome the main CCTA drawback, i.e. anatomical assessment only. The potential value of CCTA to plan and guide interventional procedures lies in the wide range of information it can provide: a) detailed evaluation of plaque extension, volume and composition; b) prediction of procedural success of CTO PCI using scores derived from CCTA; c) identification of coronary lesions requiring additional techniques (e.g., atherectomy and lithotripsy) to improve stent implantation success by assessing calcium score and calcific plaque distribution; d) assessment of CCTA-derived Syntax Score and Syntax Score II, which allows to select the mode of revascularization (PCI or CABG) in patients with complex and multivessel CAD. The aim of this Consensus Document is to review and discuss the available data supporting the role of CCTA, CT-FFR and stress CT-MPI in the preprocedural and possibly intraprocedural planning and guidance of myocardial revascularization interventions.
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Affiliation(s)
- Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy.
| | | | - Jonathon Leipsic
- St Paul's Hospital & University of British Columbia, Vancouver, British Columbia, Vancouver, Canada
| | - Koen Nieman
- Stanford University School of Medicine, Departments of Medicine and Radiology, USA
| | - Marcio Bittencurt
- Division of Internal Medicine, University Hospital, University of São Paulo, São Paulo, Brazil; DASA, São Paulo, Brazil; Division of Cardiology and the Heart and Vascular Institute, University of Pittsburgh Medical Center, USA
| | - Johan De Mey
- Department of Radiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussel, Belgium
| | - Nico Buls
- Department of Radiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussel, Belgium
| | - Yoshinobu Onuma
- Clinical Science Institute, National University of Ireland, Galway, Ireland
| | | | - Edoardo Conte
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLVZ Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy
| | - Paul Knaapen
- Vrije Universiteit Medical Center, Amsterdam, Netherlands
| | - Brian Ghoshhajra
- Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Patrick Serruys
- Clinical Science Institute, National University of Ireland, Galway, Ireland
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13
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Derda AA, Marquardt MM, Martens A, Mirena E, Vogel-Claussen J, Kempf T, Haverich A, Bauersachs J, Napp LC. Cinefluoroscopy for assessment of mechanical heart valves with suspected dysfunction. Front Cardiovasc Med 2022; 9:952255. [PMID: 36148066 PMCID: PMC9486207 DOI: 10.3389/fcvm.2022.952255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/26/2022] [Indexed: 11/26/2022] Open
Abstract
Background Mechanical heart valves (MHVs) are preferred prosthesis types in many, especially younger patients who need surgical valve replacement. Although echocardiography is most frequently performed for prosthesis assessment during follow-up, ultrasound artifacts usually preclude a precise investigation of prosthesis function. Cinefluoroscopy (CF) is a simple and effective method to analyze and quantify opening and closing of prosthesis leaflets but requires careful visualization of the valve using optimal viewing angles. Here, we investigated the quality of CF studies in clinical routine and their suitability for quantitative analysis of prosthesis function. Methods and results We retrospectively identified 94 patients with 118 cinefluoroscopies performed by 31 different investigators in one tertiary center from 2012 to 2021. Of 150 MHVs (98% bi-leaflet prostheses), 87 (58%) were aortic, 53 (34%) mitral, 7 (5%) tricuspid, and 5 (3%) pulmonary valve prostheses, respectively. CF studies were categorized by their suitability to quantitatively assess opening and closing angles. Visualization of valve function was “sufficient” in 23%, “suboptimal” in 46%, and “unsuitable” in 31% of the cases. Conclusion In clinical routine, only one-fourth of CF studies allow for a complete assessment of leaflet motion of MHVs. Although this may be in part due to the varying experience of operators, the high number of unsuitable studies suggests that optimal viewing angles may not be achievable in all patients. Further research is required to investigate standard viewing angles and anatomy after MHV implantation to improve the quality of CF studies and reduce radiation exposure of patients and operators.
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Affiliation(s)
- Anselm A. Derda
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Marvin M. Marquardt
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Andreas Martens
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Elion Mirena
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Jens Vogel-Claussen
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Tibor Kempf
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - L. Christian Napp
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
- *Correspondence: L. Christian Napp,
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14
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Ding D, Tu S, Chang Y, Li C, Xu B, Wijns W. Quantitative Flow Ratio Based on Murray Fractal Law: Accuracy of Single Versus Two Angiographic Views. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100399. [PMID: 39131462 PMCID: PMC11307523 DOI: 10.1016/j.jscai.2022.100399] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/11/2022] [Accepted: 06/13/2022] [Indexed: 08/13/2024]
Abstract
Background Murray bifurcation fractal law-based quantitative flow ratio (QFR), namely, μQFR, is a novel method for the fast computation of fractional flow reserve (FFR) from a single angiographic view. We aimed to compare the diagnostic accuracy of computational QFR based on single vs 2 angiographic views in patients with intermediate coronary stenosis. Methods The algorithm of μQFR was extended to develop a Murray law-based 3-dimensional (3D) μQFR from 2 angiographic projections. Patients with both angiographic views acquired according to the protocol-specified recommended views in the FAVOR (Functional Diagnostic Accuracy of Quantitative Flow Ratio in Online Assessment of Coronary Stenosis) II China study were included. μQFR was computed separately from the first (μQFR1) and second (μQFR2) angiographic projections, whereas the 3D-μQFR was computed based on both projections, all blinded to FFR data. Hemodynamically significant coronary stenosis was defined by wire-based FFR of ≤0.80. Results Altogether, 280 vessels from 262 patients had 2 protocol-specified recommended angiographic views; μQFR1, μQFR2, and 3D-μQFR were successfully computed in all these vessels. The mean FFR was 0.82 ± 0.12. The vessel-level diagnostic accuracy for μQFR1, μQFR2, and 3D-μQFR to identify hemodynamically significant stenosis was 92.1% (95% CI, 89.0%-95.3%), 92.5% (95% CI, 89.4%-95.6%), and 93.2% (95% CI, 90.3%-96.2%), respectively, with similar areas under the receiver operating characteristic curve for μQFR1 (0.96, P < .001), μQFR2 (0.95, P < .001), and 3D-μQFR (0.95, P < .001). μQFR1 and μQFR2 had excellent correlation (r = 0.95) and agreement (mean difference = 0.00 ± 0.03). Conclusions Computation of μQFR from a single angiographic view had comparably good diagnostic performance as 2-view 3D-μQFR in identifying hemodynamically significant coronary stenosis.
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Affiliation(s)
- Daixin Ding
- The Lambe Institute for Translational Medicine, Smart Sensors Laboratory and Curam, National University of Ireland Galway, Ireland
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Yunxiao Chang
- Shanghai Pulse Medical Technology Inc., Shanghai, China
| | - Chunming Li
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Bo Xu
- Catheterization Laboratories, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - William Wijns
- The Lambe Institute for Translational Medicine, Smart Sensors Laboratory and Curam, National University of Ireland Galway, Ireland
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15
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Albiero R, Burzotta F, Lassen JF, Lefèvre T, Banning AP, Chatzizisis YS, Johnson TW, Ferenc M, Pan M, Daremont O, Hildick-Smith D, Chieffo A, Louvard Y, Stankovic G. Treatment of coronary bifurcation lesions, part I: implanting the first stent in the provisional pathway. The 16th expert consensus document of the European Bifurcation Club. EUROINTERVENTION 2022; 18:e362-e376. [PMID: 35570748 PMCID: PMC10259243 DOI: 10.4244/eij-d-22-00165] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Stepwise layered provisional stenting (PS) is the most commonly used strategy to treat coronary bifurcation lesions (CBL). The term 'stepwise layered' emphasises the versatility of this approach that allows the adjustment of the procedure plan according to the CBL complexity, starting with stent implantation in one branch and implantation of a second stent in the other branch only when required. A series of refinements have been implemented over the years to facilitate the achievement of predictable procedural results using this approach. However, despite its simplicity and versatility, operators using this technique require full knowledge of the pitfalls of each procedural step. Part I of this 16th European Bifurcation Club consensus paper provides a detailed step-by-step overview of the pitfalls and technical troubleshooting during the implantation of the first stent using the PS strategy for the treatment of CBL.
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Affiliation(s)
- Remo Albiero
- Interventional Cardiology Unit, Ospedale Civile di Sondrio, Sondrio, Italy
| | - Francesco Burzotta
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Jens Flensted Lassen
- Department of Cardiology B, Odense Universitates Hospital & University of Southern Denmark, Odense C, Denmark
| | - Thierry Lefèvre
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France
| | - Adrian P Banning
- Cardiovascular Medicine Division, Radcliffe Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom
| | | | - Thomas W Johnson
- Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol and Weston NHSFT & University of Bristol, Bristol, United Kingdom
| | - Miroslaw Ferenc
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Manuel Pan
- Department of Cardiology, Reina Sofia Hospital. University of Cordoba (IMIBIC), Cordoba, Spain
| | | | - David Hildick-Smith
- Sussex Cardiac Centre, Royal Sussex County Hospital, Brighton and Sussex University Hospitals, Brighton, United Kingdom
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Yves Louvard
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France
| | - Goran Stankovic
- Department of Cardiology, Clinical Center of Serbia, and Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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16
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Chen F, Jia K, Li Y, Xiong T, Wang X, Zhu Z, Ou Y, Li X, Wei X, Zhao Z, Li Q, He S, Wei J, Peng Y, Feng Y, Chen M. Coronary access after transcatheter aortic valve replacement in bicuspid versus tricuspid aortic stenosis. EUROINTERVENTION 2022; 18:203-212. [PMID: 35236643 PMCID: PMC9912966 DOI: 10.4244/eij-d-21-00970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND It is unknown whether there are differences in coronary access after transcatheter aortic valve replacement (TAVR) between bicuspid and tricuspid anatomy. AIMS Our aim was to investigate coronary access after TAVR using a self-expanding transcatheter heart valve (THV) in bicuspid versus tricuspid aortic valves (BAV vs TAV), based on CT simulation. METHODS A total of 86 type 0 BAV, 70 type 1 BAV, and 132 TAV patients were included. If the coronary ostium faced the sealed parts of the THV or the tilted-up native leaflet (NL), this was defined as THV- or NL-related challenging coronary access, respectively. If coaxial engagement was not allowed due to interference from the unwrapped frame, THV-related complex coronary access was defined. RESULTS The incidence of THV-related challenging coronary access was 21.2% for the left coronary artery (LCA) and 17.7% for the right coronary artery (RCA), and type 0 BAV patients encountered fewer THV-related challenging LCA access than their TAV counterparts (OR 0.42, 95% CI: 0.20-0.89). NL-related challenging coronary access was observed in 3.1% for LCA and 1.4% for RCA, and THV-related complex coronary access was identified in 5.9% for LCA and 17.0% for RCA; however, no significant differences were found among groups. The proportion of optimal fluoroscopic viewing angles suitable for guiding LCA engagement was similar among groups (64.0% vs 70.0% vs 62.1%), but those suitable for guiding RCA engagement were significantly higher in the type 0 BAV group (31.4% vs 4.3% vs 9.1%). CONCLUSIONS Coronary access may be challenging or complex in a significant proportion of both BAV and TAV patients after TAVR. Type 0 BAV anatomy may be more favourable for post-TAVR coronary access.
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Affiliation(s)
- Fei Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Kaiyu Jia
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Yijian Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Tianyuan Xiong
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xi Wang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhongkai Zhu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuanweixiang Ou
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xi Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Wei
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhengang Zhao
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Qiao Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Sen He
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jiafu Wei
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yong Peng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuan Feng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, No.37 Guoxue Alley, Chengdu 610041, PR China
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17
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Doost A, Rankin J, Sapontis J, Ko B, Lo S, Jaltotage B, Dwivedi G, Wood D, Byrne J, Sathananthan J, Ihdayhid AR. Contemporary Evidence-Based Diagnosis and Management of Severe Coronary Artery Calcification. Heart Lung Circ 2022; 31:766-778. [PMID: 35227609 DOI: 10.1016/j.hlc.2022.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/17/2022] [Accepted: 01/22/2022] [Indexed: 02/03/2023]
Abstract
Percutaneous treatment of heavily calcified coronary lesions remains a challenge for interventional cardiologists with increased risk of incomplete lesion preparation, suboptimal stent deployment, procedural complications, and a higher rate of acute and late stent failure. Adequate lesion preparation through calcium modification is crucial in optimising procedural outcomes. Several calcium modification devices and techniques exist, with rotational atherectomy the predominant treatment for severely calcified lesions. Novel technologies such as intravascular lithotripsy are now available and show promise as a less technical and highly effective approach for calcium modification. Emerging evidence also emphasises the value of detailed characterisation of calcification severity and distribution especially with intracoronary imaging for appropriate device selection and individualised treatment strategy. This review aims to provide an overview of the non-invasive and invasive evaluation of coronary calcification, discuss calcium modification techniques and propose an algorithm for the management of calcified coronary lesions.
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Affiliation(s)
- Ata Doost
- Fiona Stanley Hospital, Perth, WA, Australia; Harry Perkins Institute of Medical Research, University of Western Australia, Perth, WA, Australia; King's College Hospital, London, UK
| | - James Rankin
- Fiona Stanley Hospital, Perth, WA, Australia; Harry Perkins Institute of Medical Research, University of Western Australia, Perth, WA, Australia
| | - James Sapontis
- Monash Heart, Monash Medical Centre, Melbourne, Vic, Australia
| | - Brian Ko
- Monash Heart, Monash Medical Centre, Melbourne, Vic, Australia
| | - Sidney Lo
- Liverpool Hospital, Sydney, NSW, Australia
| | - Biyanka Jaltotage
- Fiona Stanley Hospital, Perth, WA, Australia; Harry Perkins Institute of Medical Research, University of Western Australia, Perth, WA, Australia
| | - Girish Dwivedi
- Fiona Stanley Hospital, Perth, WA, Australia; Harry Perkins Institute of Medical Research, University of Western Australia, Perth, WA, Australia
| | - David Wood
- Centre for Cardiovascular Innovation, St. Paul's Hospital, Vancouver, BC, Canada
| | | | | | - Abdul Rahman Ihdayhid
- Fiona Stanley Hospital, Perth, WA, Australia; Harry Perkins Institute of Medical Research, University of Western Australia, Perth, WA, Australia.
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18
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Kırat T. Fundamentals of percutaneous coronary bifurcation interventions. World J Cardiol 2022; 14:108-138. [PMID: 35432773 PMCID: PMC8968454 DOI: 10.4330/wjc.v14.i3.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 07/22/2021] [Accepted: 02/22/2022] [Indexed: 02/06/2023] Open
Abstract
Coronary bifurcation lesions (CBLs) account for 15%-20% of all percutaneous coronary interventions. The complex nature of these lesions is responsible for poorer procedural, early and late outcomes. This complex lesion subset has received great attention in the interventional cardiac community, and multiple stenting techniques have been developed. Of these, the provisional stenting technique is most often the default strategy; however, the elective double stenting (EDS) technique is preferred in certain subsets of complex CBLs. The double kissing crush technique may be the preferred EDS technique because of its efficacy and safety in comparative trials; however, this technique consists of many steps and requires training. Many new methods have recently been added to the EDS techniques to provide better stent scaffolding and to reduce early and late adverse outcomes. Intravascular imaging is necessary to determine the interventional strategy and postinterventional results. This review discusses the basic concepts, contemporary percutaneous interventional technical approaches, new methods, and controversial treatment issues of CBLs.
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Affiliation(s)
- Tamer Kırat
- Department of Cardiology, Yücelen Hospital, Muğla 48000, Turkey.
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19
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Tzimas G, Gulsin GS, Takagi H, Mileva N, Sonck J, Muller O, Leipsic JA, Collet C. Coronary CT Angiography to Guide Percutaneous Coronary Intervention. Radiol Cardiothorac Imaging 2022; 4:e210171. [PMID: 35782760 PMCID: PMC8893214 DOI: 10.1148/ryct.210171] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 11/08/2021] [Accepted: 11/22/2021] [Indexed: 05/03/2023]
Abstract
Coronary CT angiography (CCTA) has emerged as a powerful noninvasive tool for characterizing the presence, extent, and severity of coronary artery disease (CAD) in patients with stable angina. Recent technological advancements in CT scanner hardware and software have augmented the rich information that can be derived from a single CCTA study. Beyond merely identifying the presence of CAD and assessing stenosis severity, CCTA now allows for the identification and characterization of plaques, lesion length, and fluoroscopic angle optimization, as well as enables the assessment of the physiologic extent of stenosis through CT-derived fractional flow reserve, and may even allow for the prediction of the response to revascularization. These and other features make CCTA capable of not only guiding invasive coronary angiography referral, but also give it the unique ability to help plan coronary intervention. This review summarizes current and future applications of CCTA in procedural planning for percutaneous coronary intervention, provides rationale for wider integration of CCTA in the workflow of the interventional cardiologist, and details how CCTA may help improve patient care and clinical outcomes. Keywords: CT Angiography © RSNA, 2022.
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Affiliation(s)
- Georgios Tzimas
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z4 (G.T., G.S.G., H.T.,
J.A.L.); Department of Heart Vessels, Cardiology Service, Lausanne University
Hospital and University of Lausanne, Lausanne, Switzerland (G.T., O.M.);
University of Leicester and the Leicester NIHR Biomedical Research Centre,
Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, England
(G.S.G.); Department of Diagnostic Radiology, Tohoku University Hospital,
Sendai, Japan (H.T.); Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
(N.M., J.S., C.C.); and Department of Advanced Biomedical Sciences, Federico II
University, Naples, Italy (J.S.)
| | - Gaurav S. Gulsin
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z4 (G.T., G.S.G., H.T.,
J.A.L.); Department of Heart Vessels, Cardiology Service, Lausanne University
Hospital and University of Lausanne, Lausanne, Switzerland (G.T., O.M.);
University of Leicester and the Leicester NIHR Biomedical Research Centre,
Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, England
(G.S.G.); Department of Diagnostic Radiology, Tohoku University Hospital,
Sendai, Japan (H.T.); Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
(N.M., J.S., C.C.); and Department of Advanced Biomedical Sciences, Federico II
University, Naples, Italy (J.S.)
| | - Hidenobu Takagi
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z4 (G.T., G.S.G., H.T.,
J.A.L.); Department of Heart Vessels, Cardiology Service, Lausanne University
Hospital and University of Lausanne, Lausanne, Switzerland (G.T., O.M.);
University of Leicester and the Leicester NIHR Biomedical Research Centre,
Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, England
(G.S.G.); Department of Diagnostic Radiology, Tohoku University Hospital,
Sendai, Japan (H.T.); Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
(N.M., J.S., C.C.); and Department of Advanced Biomedical Sciences, Federico II
University, Naples, Italy (J.S.)
| | - Niya Mileva
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z4 (G.T., G.S.G., H.T.,
J.A.L.); Department of Heart Vessels, Cardiology Service, Lausanne University
Hospital and University of Lausanne, Lausanne, Switzerland (G.T., O.M.);
University of Leicester and the Leicester NIHR Biomedical Research Centre,
Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, England
(G.S.G.); Department of Diagnostic Radiology, Tohoku University Hospital,
Sendai, Japan (H.T.); Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
(N.M., J.S., C.C.); and Department of Advanced Biomedical Sciences, Federico II
University, Naples, Italy (J.S.)
| | - Jeroen Sonck
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z4 (G.T., G.S.G., H.T.,
J.A.L.); Department of Heart Vessels, Cardiology Service, Lausanne University
Hospital and University of Lausanne, Lausanne, Switzerland (G.T., O.M.);
University of Leicester and the Leicester NIHR Biomedical Research Centre,
Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, England
(G.S.G.); Department of Diagnostic Radiology, Tohoku University Hospital,
Sendai, Japan (H.T.); Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
(N.M., J.S., C.C.); and Department of Advanced Biomedical Sciences, Federico II
University, Naples, Italy (J.S.)
| | - Olivier Muller
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z4 (G.T., G.S.G., H.T.,
J.A.L.); Department of Heart Vessels, Cardiology Service, Lausanne University
Hospital and University of Lausanne, Lausanne, Switzerland (G.T., O.M.);
University of Leicester and the Leicester NIHR Biomedical Research Centre,
Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, England
(G.S.G.); Department of Diagnostic Radiology, Tohoku University Hospital,
Sendai, Japan (H.T.); Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
(N.M., J.S., C.C.); and Department of Advanced Biomedical Sciences, Federico II
University, Naples, Italy (J.S.)
| | - Jonathon A. Leipsic
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z4 (G.T., G.S.G., H.T.,
J.A.L.); Department of Heart Vessels, Cardiology Service, Lausanne University
Hospital and University of Lausanne, Lausanne, Switzerland (G.T., O.M.);
University of Leicester and the Leicester NIHR Biomedical Research Centre,
Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, England
(G.S.G.); Department of Diagnostic Radiology, Tohoku University Hospital,
Sendai, Japan (H.T.); Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
(N.M., J.S., C.C.); and Department of Advanced Biomedical Sciences, Federico II
University, Naples, Italy (J.S.)
| | - Carlos Collet
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z4 (G.T., G.S.G., H.T.,
J.A.L.); Department of Heart Vessels, Cardiology Service, Lausanne University
Hospital and University of Lausanne, Lausanne, Switzerland (G.T., O.M.);
University of Leicester and the Leicester NIHR Biomedical Research Centre,
Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, England
(G.S.G.); Department of Diagnostic Radiology, Tohoku University Hospital,
Sendai, Japan (H.T.); Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
(N.M., J.S., C.C.); and Department of Advanced Biomedical Sciences, Federico II
University, Naples, Italy (J.S.)
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20
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Khokhar AA, Zelias A, Zlahoda‐Huzior A, Dudek D. Complication during robotic‐PCI: Iatrogenic guiding catheter dissection. Catheter Cardiovasc Interv 2022; 99:1526-1528. [DOI: 10.1002/ccd.30107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Arif A. Khokhar
- Department of Cardiology Imperial College Healthcare NHS Trust London UK
- Digital Innovations & Robotics Hub Krakow Poland
| | - Aleksander Zelias
- Center for Invasive Cardiology Electrotherapy, and Angiology in Nowy Sacz Poland
| | - Adriana Zlahoda‐Huzior
- Digital Innovations & Robotics Hub Krakow Poland
- Department of Measurement and Electronics AGH University of Science and Technology Krakow Poland
| | - Dariusz Dudek
- Institute of Cardiology Jagiellonian University Medical College Krakow Poland
- GVM Care & Research Maria Cecilia Hospital Cotignola Italy
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21
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Affiliation(s)
- Luiz F Ybarra
- London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada (L.F.Y.)
| | - Nicolo Piazza
- Department of Medicine, Division of Cardiology, McGill University Health Centre, Montreal, QC, Canada (N.P.)
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22
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Sun W, Yang G, Chen Y, Shu H. An adaptive optimal viewing angle determination algorithm for TEVAR operation. BMC Med Imaging 2021; 21:141. [PMID: 34600478 PMCID: PMC8487120 DOI: 10.1186/s12880-021-00676-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 09/28/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The determination of the right x-ray angiography viewing angle is an important issue during the treatment of thoracic endovascular aortic repair (TEVAR). An inaccurate projection angle (manually determined today by the physicians according to their personal experience) may affect the placement of the stent and cause vascular occlusion or endoleak. METHODS Based on the acquisition of a computed tomography angiography (CTA) image before TEVAR, an adaptive optimization algorithm is proposed to determine the optimal viewing angle of the angiogram automatically. This optimal view aims at avoiding any overlapping between the left common carotid artery and the left subclavian artery. Moreover, the proposed optimal procedure exploits the patient-specific morphology to adaptively reduce the potential foreshortening effect. RESULTS Experimental results conducted on thirty-five patients demonstrate that the optimal angiographic viewing angle based on the proposed method has no significant difference when compared with the expert practice (p = 0.0678). CONCLUSION We propose a method that utilizes the CTA image acquired before TEVAR to automatically calculate the optimal C-arm angle. This method has the potential to assist surgeons during their interventional procedure by providing a shorter procedure time, less radiation exposure, and less contrast injection.
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Affiliation(s)
- Weiya Sun
- Laboratory of Image Science and Technology, Key Laboratory of Computer Network and Information Integration, School of Computer Science and Engineering, Southeast University, Nanjing, 210096 China
| | - Guanyu Yang
- Laboratory of Image Science and Technology, Key Laboratory of Computer Network and Information Integration, School of Computer Science and Engineering, Southeast University, Nanjing, 210096 China
- Centre de Recherche en Information BioMdicale Sino-Franais (CRIBs), Nanjing, China
| | - Yang Chen
- Laboratory of Image Science and Technology, Key Laboratory of Computer Network and Information Integration, School of Computer Science and Engineering, Southeast University, Nanjing, 210096 China
- Centre de Recherche en Information BioMdicale Sino-Franais (CRIBs), Nanjing, China
| | - Huazhong Shu
- Laboratory of Image Science and Technology, Key Laboratory of Computer Network and Information Integration, School of Computer Science and Engineering, Southeast University, Nanjing, 210096 China
- Centre de Recherche en Information BioMdicale Sino-Franais (CRIBs), Nanjing, China
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23
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Spilias N, Sabbak N, Harb SC, Yun JJ, Vargo PR, Unai S, Puri R, Reed GW, Krishnaswamy A, Kapadia SR. A Novel Method of Assessing Commissural Alignment for the SAPIEN 3 Transcatheter Aortic Valve. JACC Cardiovasc Interv 2021; 14:1269-1272. [PMID: 34112468 DOI: 10.1016/j.jcin.2021.03.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/08/2021] [Accepted: 03/23/2021] [Indexed: 10/21/2022]
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Gong X, Huang Z, Sun Z, Wang Q, Qian J, Ge L, Ge J. Role of IVUS in the rectification of angiographically judged ramus intermedius and its clinical significance. BMC Cardiovasc Disord 2021; 21:218. [PMID: 33931019 PMCID: PMC8086063 DOI: 10.1186/s12872-021-02034-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 04/16/2021] [Indexed: 11/25/2022] Open
Abstract
Background Due to the technical limitations of coronary artery angiography (CAG), ramus intermedius (RI) is sometimes difficult to distinguish from a high-origin obtuse marginal branch or a high-origin diagonal branch. This study sought to investigate the role of intravascular ultrasonography (IVUS) in the rectification of angiographically judged RI. Methods This study retrospectively analyzed 165 patients who were reported to have an RI based on CAG and underwent IVUS implementation from 02/01/2009 to 31/12/2019 in Zhongshan Hospital, Fudan University. Taking IVUS as the gold standard, we calculated the accuracy of RI identification by CAG and evaluated the impact of RI on revascularization strategy. Results Among the 165 patients, 89 patients (54%) were demonstrated to have an RI on IVUS (IVUS-RI), 32 patients (19%) were identified to have a high-origin diagonal branch on IVUS (IVUS-h-D), and 44 patients (27%) had an actual high-origin obtuse marginal artery on IVUS (IVUS-h-OM). Among 84 patients who underwent one-stent crossover stenting because of left main furcation lesions (48 patients in the IVUS-RI group, 12 patients in the IVUS-h-D group, and 24 in the IVUS-h-OM group), 14.6% of patients in the IVUS-RI group, 33.3% in the IVUS-h-D group and 0% in the IVUS-h-OM group had CAG-RI compromise (P = 0.02), which was defined as severe stenosis of the RI ostium (> 75%) or significant RI flow impairment (TIMI < 3). Conclusions Only 54% of CAG-RIs were confirmed by IVUS, which indicates the necessity of preintervention IVUS to distinguish real RIs from other branches in LM furcation lesions.
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Affiliation(s)
- Xue Gong
- Department of Cardiology, Deltahealth Hospital, Shanghai, 201702, People's Republic of China.,Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Zheyong Huang
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Zhonghan Sun
- Human Phenome Institute, Fudan University, Shanghai, 200438, People's Republic of China
| | - Qibing Wang
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Juying Qian
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Lei Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China.
| | - Junbo Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China.
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25
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Mancini GBJ, Leipsic J, Budoff MJ, Hague CJ, Min JK, Stevens SR, Reynolds HR, O'Brien SM, Shaw LJ, Manjunath CN, Mavromatis K, Demkow M, Lopez-Sendon JL, Chernavskiy AM, Gosselin G, Schuchlenz H, Devlin GP, Chauhan A, Bangalore S, Hochman JS, Maron DJ. CT Angiography Followed by Invasive Angiography in Patients With Moderate or Severe Ischemia-Insights From the ISCHEMIA Trial. JACC Cardiovasc Imaging 2021; 14:1384-1393. [PMID: 33454249 DOI: 10.1016/j.jcmg.2020.11.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 11/02/2020] [Accepted: 11/05/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES This study aimed to examine the concordance of coronary computed tomographic angiography (CCTA) assessment of coronary anatomy and invasive coronary angiography (ICA) as the reference standard in patients enrolled in the ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches). BACKGROUND Performance of CCTA compared with ICA has not been assessed in patients with very high burdens of stress-induced ischemia and a high likelihood of anatomically significant coronary artery disease (CAD). A blinded CCTA was performed after enrollment to exclude patients with left main (LM) disease or no obstructive CAD before randomization to an initial conservative or invasive strategy, the latter guided by ICA and optimal revascularization. METHODS Rates of concordance were calculated on a per-patient basis in patients randomized to the invasive strategy. Anatomic significance was defined as ≥50% diameter stenosis (DS) for both modalities. Sensitivity analyses using a threshold of ≥70% DS for CCTA or considering only CCTA images of good-to-excellent quality were performed. RESULTS In 1,728 patients identified by CCTA as having no LM disease ≥50% and at least single-vessel CAD, ICA confirmed 97.1% without LM disease ≥50%, 92.2% with at least single-vessel CAD and no LM disease ≥50%, and only 4.9% without anatomically significant CAD. Results using a ≥70% DS threshold or only CCTA of good-to-excellent quality showed similar overall performance. CONCLUSIONS CCTA before randomization in ISCHEMIA demonstrated high concordance with subsequent ICA for identification of patients with angiographically significant disease without LM disease.
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Affiliation(s)
- G B John Mancini
- Center for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Jonathan Leipsic
- Center for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Cameron J Hague
- Center for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada; St. Paul's Hospital Department of Radiology, Vancouver, British Columbia, Canada
| | | | | | - Harmony R Reynolds
- New York University Grossman School of Medicine, New York, New York, USA
| | - Sean M O'Brien
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | | | | | | | | | | | - Alexander M Chernavskiy
- E.Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russia
| | | | - Herwig Schuchlenz
- LKH Graz II, Department fuer Kardiologie und Intensivmedizin, Graz, Austria
| | | | - Anoop Chauhan
- Blackpool Teaching Hospitals, Lancashire, United Kingdom
| | - Sripal Bangalore
- New York University Grossman School of Medicine, New York, New York, USA
| | - Judith S Hochman
- New York University Grossman School of Medicine, New York, New York, USA
| | - David J Maron
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
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Sadamatsu K, Okutsu M, Sumitsuji S, Kawasaki T, Nakamura S, Fukumoto Y, Tsujita K, Sonoda S, Kobayashi Y, Ikari Y. Practical utilization of cardiac computed tomography for the success in complex coronary intervention. Cardiovasc Interv Ther 2021; 36:178-189. [PMID: 33428155 DOI: 10.1007/s12928-020-00751-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 12/22/2020] [Indexed: 12/12/2022]
Abstract
Percutaneous coronary intervention (PCI) for complex lesions is still technically demanding and is associated with less favorable procedural parameters such as lower success rate, longer procedural time, higher contrast volume and unexpected complications. Because the conventional angiographic analysis is limited by the inability to visualize the plaque information and the occluded segment, cardiac computed tomography has evolved as an adjunct to invasive angiography to better characterize coronary lesions to improve success rates of PCI. Adding to routine image reconstructions by coronary computed tomography angiography, the thin-slab maximum intensity projection method, which is a handy reconstruction technique on an ordinary workstation, could provide easy-to-understand images to reveal the anatomical characteristics and the lumen and plaque information simultaneously, and then assist to build an in-depth strategy for PCI. Especially in the treatment of chronic total occlusion lesion, these informations have big advantages in the visualization of the morphologies of entry and exit, the occluded segment and the distribution of calcium compared to invasive coronary angiography. Despite of the additional radiation exposure, contrast use and cost for cardiac computed tomography, the precise analysis of lesion characteristics would consequently improve the procedural success and prevent the complication in complex PCI.
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Affiliation(s)
- Kenji Sadamatsu
- Department of Cardiovascular Medicine, Omuta City Hospital, 2-19-1 Takarazaka-machi, Omuta, Fukuoka, 836-8567, Japan.
| | - Masaaki Okutsu
- Department of Cardiovascular Medicine, New Tokyo Hospital, Matsudo, Japan
| | - Satoru Sumitsuji
- Department of Cardiology for International Education and Research, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tomohiro Kawasaki
- Cardiovascular and Heart Rhythm Center, Shin-Koga Hospital, Kurume, Japan
| | - Sunao Nakamura
- Department of Cardiovascular Medicine, New Tokyo Hospital, Matsudo, Japan
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Kumamoto University Graduate School of Medical Science, Kumamoto, Japan
| | - Shinjo Sonoda
- Second Department of Internal Medicine, School of Medicine, University of Occupational and Environ- Mental Health, Kitakyushu, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yuji Ikari
- Department of Cardiology, Tokai University, Kanagawa, Japan
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27
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Hennessey B, Vera-Urquiza R, Mejía-Rentería H, Gonzalo N, Escaned J. Contemporary use of coronary computed tomography angiography in the planning of percutaneous coronary intervention. Int J Cardiovasc Imaging 2020; 36:2441-2459. [DOI: 10.1007/s10554-020-02052-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 09/29/2020] [Indexed: 02/06/2023]
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28
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Carroll JD, Chen SYJ. The Use of CTCA for Planning PCI: Using the 3D Coronary Tree Information. JACC Cardiovasc Interv 2020; 13:2571-2573. [PMID: 33153570 DOI: 10.1016/j.jcin.2020.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 11/25/2022]
Affiliation(s)
- John D Carroll
- Cardiology Division, University of Colorado School of Medicine, Aurora, Colorado.
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