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Ellis SG, Gori T, Serruys PW, Nef H, Steffenino G, Brugaletta S, Munzel T, Feliz C, Schmidt G, Sabaté M, Onuma Y, van Geuns RJ, Gao RL, Menichelli M, Kereiakes DJ, Stone GW, Testa L, Kimura T, Abizaid A. Clinical, Angiographic, and Procedural Correlates of Very Late Absorb Scaffold Thrombosis: Multistudy Registry Results. JACC Cardiovasc Interv 2019; 11:638-644. [PMID: 29622141 DOI: 10.1016/j.jcin.2017.11.042] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 11/28/2017] [Accepted: 11/29/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The aim of this study was to identify independent correlates of very late scaffold thrombosis (VLST) from an analysis of consecutively treated patients from 15 multicenter studies. BACKGROUND Recent analyses suggest an increased risk for VLST with the Absorb Bioresorbable Vascular Scaffold compared with drug-eluting stents, but insights as to correlates of risk are limited. METHODS A total of 55 patients were identified with scaffold thrombosis. They were matched 2:1 with control subjects selected randomly from patients without thrombosis from the same study. Quantitative coronary angiography was available for 96.4% of patients. Multiple logistic and Cox regression analysis were used to identify significant independent outcome correlates from 6 pre-specified characteristics. RESULTS Patients had scaffold thrombosis at a median of 20 months (interquartile range: 17 to 27 months). Control subjects were followed for 36 months (interquartile range: 24 to 38 months). For the combined groups, reference vessel diameter (RVD) was 2.84 ± 0.50 mm, scaffold length was 26 ± 16 mm, and post-dilatation was performed in 56%. Univariate correlates of thrombosis were smaller nominal scaffold/RVD ratio (linear p = 0.001; ratio <1.18:1; odds ratio: 7.5; p = 0.002) and larger RVD (linear p = 0.001; >2.72 mm; odds ratio: 3.4; p = 0.001). Post-dilatation at ≥16 atm, post-dilatation balloon/scaffold ratio, final percentage stenosis, and dual antiplatelet therapy were not correlated with VLST. Only scaffold/RVD ratio remained a significant independent correlate of VLST (p = 0.001), as smaller ratio was correlated with RVD (p < 0.001). Post hoc analysis of 8 other potential covariates revealed no other correlates of outcome. CONCLUSIONS In the present analysis, the largest to date of its type, relative scaffold undersizing was the strongest determinant of VLST. Given current understanding of "scaffold dismantling," this finding likely has ramifications for all bioresorbable scaffolds.
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Affiliation(s)
| | - Tommaso Gori
- Kardiologie I, Universitatsmedizin Mainz and DZHK Standort Rhein-Main, Germany
| | - Patrick W Serruys
- Cardiovascular Science Division of the National Heart and Lung Institute (NHLI), Faculty of Medicine, Imperial College, London, United Kingdom
| | - Holger Nef
- UKGM Universitatsklinikum Giessen, Giessen, Germany
| | | | | | - Thomas Munzel
- Kardiologie I, Universitatsmedizin Mainz and DZHK Standort Rhein-Main, Germany
| | - Cordula Feliz
- Cardiovascular Science Division of the National Heart and Lung Institute (NHLI), Faculty of Medicine, Imperial College, London, United Kingdom
| | - Götz Schmidt
- UKGM Universitatsklinikum Giessen, Giessen, Germany
| | - Manel Sabaté
- Hospital Clinic, Institut Clinic Cardiovascular, Barcelona, Spain
| | - Yoshinobu Onuma
- Cardiovascular Science Division of the National Heart and Lung Institute (NHLI), Faculty of Medicine, Imperial College, London, United Kingdom
| | - R J van Geuns
- Cardiovascular Science Division of the National Heart and Lung Institute (NHLI), Faculty of Medicine, Imperial College, London, United Kingdom
| | - Run-Lin Gao
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | | | - Dean J Kereiakes
- The Christ Hospital Heart and Vascular Center and The Lindner Research Center, Cincinnati, Ohio
| | - Gregg W Stone
- Columbia University Medical Center, NewYork-Presbyterian Hospital, New York, New York
| | - Luca Testa
- IRCCS Policlinico San Donato Department of Cardiology, Milan, Italy
| | - Takeshi Kimura
- Department of Cardiovascular Medicine at Kyoto University, Kyoto, Japan
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Everaert B, Wykrzykowska JJ, Koolen J, van der Harst P, den Heijer P, Henriques JP, van der Schaaf R, de Smet B, Hofma SH, Diletti R, Weevers A, Hoorntje J, Smits P, van Geuns RJ. Recommendations for the use of bioresorbable vascular scaffolds in percutaneous coronary interventions : 2017 revision. Neth Heart J 2017; 25:419-428. [PMID: 28643297 PMCID: PMC5513994 DOI: 10.1007/s12471-017-1014-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND To eliminate some of the potential late limitations of permanent metallic stents, the bioresorbable coronary stents or 'bioresorbable vascular scaffolds' (BVS) have been developed. METHODS We reviewed all currently available clinical data on BVS implantation. RESULTS Since the 2015 position statement on the appropriateness of BVS in percutaneous coronary interventions, several large randomised trials have been presented. These have demonstrated that achieving adequate 1 and 2 year outcomes with these first-generation BVS is not straightforward. These first adequately powered studies in non-complex lesions showed worse results if standard implantation techniques were used for these relatively thick scaffolds. Post-hoc analyses hypothesise that outcomes similar to current drug-eluting stents are still possible if aggressive lesion preparation, adequate sizing and high-pressure postdilatation are implemented rigorously. As long as this has not been confirmed in prospective studies the usage should be restricted to experienced centres with continuous outcome monitoring. For more complex lesions, results are even more disappointing and usage should be discouraged. When developed, newer generation scaffolds with thinner struts or faster resorption rates are expected to improve outcomes. In the meantime prolonged dual antiplatelet therapy (DAPT, beyond one year) is recommended in an individualised approach for patients treated with current generation BVS. CONCLUSION The new 2017 recommendations downgrade and limit the use of the current BVS to experienced centres within dedicated registries using the updated implantation protocol and advise the prolonged usage of DAPT. In line with these recommendations the manufacturer does not supply devices to the hospitals without such registries in place.
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Affiliation(s)
- B Everaert
- Thoraxcenter, Erasmus Medical Centre, Rotterdam, The Netherlands
- Monica Hospital, Antwerp, Belgium
| | | | - J Koolen
- Catharina Hospital, Eindhoven, The Netherlands
| | - P van der Harst
- University Medical Center, University of Groningen, Groningen, The Netherlands
| | | | | | | | - B de Smet
- Meander Medical Center, Amersfoort, The Netherlands
| | - S H Hofma
- Medical Center, Leeuwarden, The Netherlands
| | - R Diletti
- Thoraxcenter, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - A Weevers
- Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - J Hoorntje
- Maastricht University Medical Center, Maastricht, The Netherlands
| | - P Smits
- Maasstad Hospital, Rotterdam, The Netherlands
| | - R J van Geuns
- Thoraxcenter, Erasmus Medical Centre, Rotterdam, The Netherlands.
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Diletti R, Karanasos A, Muramatsu T, Nakatani S, Van Mieghem NM, Onuma Y, Nauta ST, Ishibashi Y, Lenzen MJ, Ligthart J, Schultz C, Regar E, de Jaegere PP, Serruys PW, Zijlstra F, van Geuns RJ. Everolimus-eluting bioresorbable vascular scaffolds for treatment of patients presenting with ST-segment elevation myocardial infarction: BVS STEMI first study. Eur Heart J 2014; 35:777-86. [DOI: 10.1093/eurheartj/eht546] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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Simsek C, Räber L, Magro M, Boersma E, Onuma Y, Stefanini GG, Zanchin T, Kalesan B, Wenaweser P, Jüni P, van Geuns RJ, van Domburg RT, Windecker S, Serruys PWJC. Long-term outcome of the unrestricted use of everolimus-eluting stents compared to sirolimus-eluting stents and paclitaxel-eluting stents in diabetic patients: the Bern-Rotterdam diabetes cohort study. Int J Cardiol 2013; 170:36-42. [PMID: 24196314 DOI: 10.1016/j.ijcard.2013.10.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Revised: 08/28/2013] [Accepted: 10/05/2013] [Indexed: 01/22/2023]
Abstract
BACKGROUND Newer generation everolimus-eluting stents (EES) improve clinical outcome compared to early generation sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES). We investigated whether the advantage in safety and efficacy also holds among the high-risk population of diabetic patients during long-term follow-up. METHODS Between 2002 and 2009, a total of 1963 consecutive diabetic patients treated with the unrestricted use of EES (n=804), SES (n=612) and PES (n=547) were followed throughout three years for the occurrence of cardiac events at two academic institutions. The primary end point was the occurrence of definite stent thrombosis. RESULTS The primary outcome occurred in 1.0% of EES, 3.7% of SES and 3.8% of PES treated patients ([EES vs. SES] adjusted HR=0.58, 95% CI 0.39-0.88; [EES vs. PES] adjusted HR=0.29, 95% CI 0.13-0.67). Similarly, patients treated with EES had a lower risk of target-lesion revascularization (TLR) compared to patients treated with SES and PES ([EES vs. SES], 5.6% vs. 11.5%, adjusted HR=0.68, 95% CI: 0.55-0.83; [EES vs. PES], 5.6% vs. 11.3%, adjusted HR=0.51, 95% CI: 0.33-0.77). There were no differences in other safety end points, such as all-cause mortality, cardiac mortality, myocardial infarction (MI) and MACE. CONCLUSION In diabetic patients, the unrestricted use of EES appears to be associated with improved outcomes, specifically a significant decrease in the need for TLR and ST compared to early generation SES and PES throughout 3-year follow-up.
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Affiliation(s)
- C Simsek
- Thoraxcenter, Department of Cardiology, Erasmus Medical Center Rotterdam, The Netherlands
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Rossi A, Dharampal A, Wragg A, Davies LC, van Geuns RJ, Anagnostopoulos C, Klotz E, Kitslaar P, Broersen A, Mathur A, Nieman K, Hunink MGM, de Feyter PJ, Petersen SE, Pugliese F. Diagnostic performance of hyperaemic myocardial blood flow index obtained by dynamic computed tomography: does it predict functionally significant coronary lesions? Eur Heart J Cardiovasc Imaging 2013; 15:85-94. [DOI: 10.1093/ehjci/jet133] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kirişli HA, Gupta V, Kirschbaum SW, Rossi A, Metz CT, Schaap M, van Geuns RJ, Mollet N, Lelieveldt BPF, Reiber JHC, van Walsum T, Niessen WJ. Comprehensive visualization of multimodal cardiac imaging data for assessment of coronary artery disease: first clinical results of the SMARTVis tool. Int J Comput Assist Radiol Surg 2011; 7:557-71. [PMID: 21948075 DOI: 10.1007/s11548-011-0657-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Accepted: 08/25/2011] [Indexed: 12/29/2022]
Abstract
PURPOSE In clinical practice, both coronary anatomy and myocardial perfusion information are needed to assess coronary artery disease (CAD). The extent and severity of coronary stenoses can be determined using computed tomography coronary angiography (CTCA); the presence and amount of ischemia can be identified using myocardial perfusion imaging, such as perfusion magnetic resonance imaging (PMR). To determine which specific stenosis is associated with which ischemic region, experts use assumptions on coronary perfusion territories. Due to the high variability between patient's coronary artery anatomies, as well as the uncertain relation between perfusion territories and supplying coronary arteries, patient-specific systems are needed. MATERIAL AND METHODS We present a patient-specific visualization system, called Synchronized Multimodal heART Visualization (SMARTVis), for relating coronary stenoses and perfusion deficits derived from CTCA and PMR, respectively. The system consists of the following comprehensive components: (1) two or three-dimensional fusion of anatomical and functional information, (2) automatic detection and ranking of coronary stenoses, (3) estimation of patient-specific coronary perfusion territories. RESULTS The potential benefits of the SMARTVis tool in assessing CAD were investigated through a case-study evaluation (conventional vs. SMARTVis tool): two experts analyzed four cases of patients with suspected multivessel coronary artery disease. When using the SMARTVis tool, a more reliable estimation of the relation between perfusion deficits and stenoses led to a more accurate diagnosis, as well as a better interobserver diagnosis agreement. CONCLUSION The SMARTVis comprehensive visualization system can be effectively used to assess disease status in multivessel CAD patients, offering valuable new options for the diagnosis and management of these patients.
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Affiliation(s)
- Hortense A Kirişli
- Biomedical Imaging Group Rotterdam (BIGR), Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands.
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Schultz CJ, Moelker A, Piazza N, Tzikas A, Otten A, Nuis RJ, Neefjes LA, van Geuns RJ, de Feyter P, Krestin G, Serruys PW, de Jaegere PP. Three dimensional evaluation of the aortic annulus using multislice computer tomography: are manufacturer's guidelines for sizing for percutaneous aortic valve replacement helpful? Eur Heart J 2009; 31:849-56. [DOI: 10.1093/eurheartj/ehp534] [Citation(s) in RCA: 144] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Gonzalo N, Serruys PW, Okamura T, Shen ZJ, Onuma Y, Garcia-Garcia HM, Sarno G, Schultz C, van Geuns RJ, Ligthart J, Regar E. Optical coherence tomography assessment of the acute effects of stent implantation on the vessel wall: a systematic quantitative approach. Heart 2009; 95:1913-9. [PMID: 19671534 DOI: 10.1136/hrt.2009.172072] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To observe and characterise vessel injury after stenting using optical coherence tomography (OCT), to propose a systematic OCT classification for periprocedural vessel trauma, to evaluate its frequency in stable versus unstable patients and to assess its clinical impact during the hospitalisation period. SETTING Stenting causes vessel injury. DESIGN AND INTERVENTIONS All consecutive patients in whom OCT was performed after stent implantation were included in the study. Qualitative and quantitative assessment of tissue prolapse, intra-stent dissection and edge dissection were performed. RESULTS Seventy-three patients (80 vessels) were analysed. Tissue prolapse within the stented segment was visible in 78/80 vessels (97.5%). Median number of tissue prolapse sites was 8 (IQR 4-19), mean (SD) area 1.04 (0.9) mm(2). Intra-stent dissection flaps were visible in 69/80 vessels (86.3%) (median number 3 (IQR 1.25-6), maximum flap length 450 (220) microm). Fifty-five out of 80 vessels (68.8%) showed dissection cavities (median number 2 (IQR 0-4.75), maximum depth 340 (170) microm). Edge dissection was visible in 20 vessels (mean (SD) length flap 744 (439) microm). The frequency of tissue prolapse or intra-stent dissection was similar in stable and unstable patients (95.6% vs 100%, p = 0.5 for tissue prolapse; 91.1% vs 82.9%, p = 0.3 for intra-stent dissection). There were no events during the hospitalisation period. CONCLUSIONS OCT allows a detailed visualisation of vessel injury after stent implantation and enables a systematic classification and quantification in vivo. In this study, frequency of tissue prolapse or intra-stent dissections after stenting was high, irrespective of the clinical presentation of the patients, and was not associated with clinical events during hospitalisation.
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Affiliation(s)
- N Gonzalo
- Thoraxcenter, Erasmus MC, 3015-CE Rotterdam, The Netherlands
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9
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Moelker AD, Baks T, van den Bos EJ, van Geuns RJ, de Feyter PJ, Duncker DJ, van der Giessen WJ. Reduction in infarct size, but no functional improvement after bone marrow cell administration in a porcine model of reperfused myocardial infarction. Eur Heart J 2006; 27:3057-64. [PMID: 17135284 DOI: 10.1093/eurheartj/ehl401] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Stem cell therapy after myocardial infarction (MI) has been studied in models of permanent coronary occlusion. We studied the effect of intracoronary administration of unselected bone marrow (BM) and mononuclear cells (MNC) in a porcine model of reperfused MI. METHODS AND RESULTS In 34 swine, the left circumflex coronary artery was balloon-occluded for 2 h followed by reperfusion. Ten swine without MI served as controls. All swine underwent magnetic resonance imaging (MRI) 1 week post-MI. The next day, 10 of the 30 surviving MI swine received BM, 10 other MI swine received MNC, and the remaining MI swine received medium intracoronary. Four weeks later, all swine underwent a follow-up MRI. One week after MI, end-diastolic volume (92+/-16 mL) and left ventricular (LV) weight (78+/-12 g) were greater, whereas ejection fraction (40+/-8%) was lower than in controls (69+/-11 mL, 62+/-13 g, and 53+/-6%). Injection of BM or MNC had no effect on the MI-induced changes in global or regional LV-function. However, there was a significant reduction in infarct size 4 weeks after MNC injection (-6+/-3%) compared with the medium (-3+/-5%). CONCLUSION Intracoronary injection of BM or MNC in swine does not improve regional or global LV-function 4 weeks after injection. However, a reduction in infarct-size was noted after MNC injection.
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Affiliation(s)
- Amber D Moelker
- Department of Cardiology, Thoraxcenter, Ba 587, Erasmus MC, University Medical Center Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands
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de Feyter PJ, Serruys PW, Nieman K, Mollet N, Cademartiri F, van Geuns RJ, Slager C, van der Steen AFW, Krams R, Schaar JA, Wielopolski P, Pattynama PMT, Arampatzis A, van der Lugt A, Regar E, Ligthart J, Smits P. Imaging of coronary atherosclerosis and identification of the vulnerable plaque. Neth Heart J 2003; 11:347-358. [PMID: 25696244 PMCID: PMC2499949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
Identification of the vulnerable plaque responsible for the occurrence of acute coronary syndromes and acute coronary death is a prerequisite for the stabilisation of this vulnerable plaque. Comprehensive coronary atherosclerosis imaging in clinical practice should involve visualisation of the entire coronary artery tree and characterisation of the plaque, including the three-dimensional morphology of the plaque, encroachment of the plaque on the vessel lumen, the major tissue components of the plaque, remodelling of the vessel and presence of inflammation. Obviously, no single diagnostic modality is available that provides such comprehensive imaging and unfortunately no diagnostic tool is available that unequivocally identifies the vulnerable plaque. The objective of this article is to discuss experience with currently available diagnostic modalities for coronary atherosclerosis imaging. In addition, a number of evolving techniques will be briefly discussed.
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van Geuns RJ, Wielopolski PA, Wardeh AJ, de Bruin HG, Oudkerk M, de Feyter PJ. Volume coronary angiography using targeted scans (VCATS): a new strategy in MR coronary angiography. Int J Cardiovasc Imaging 2001; 17:405-10. [PMID: 12025954 DOI: 10.1023/a:1011915711030] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The aim of this study was to explore the clinical possibilities of a new strategy for magnetic resonance imaging of the coronary arteries. Thirteen patients were studied by volume coronary angiography using targeted scans (VCATS) to visualize the major coronary arteries in a series of breath-holds. The proximal coronary arteries were clearly seen in 92% and the mid segments in 50-70% of the patients. VCATS was able to visualize a total vessel length of the left main (LM) (mean: 9.4+/-3.4 mm), of the left anterior descending (LAD) 69+/-20 mm, of the right coronary artery (RCA) 90+/-33 mm and of the left circumflex (LCX) 41+/-18 mm. There was a reasonable correlation between the VCATS and conventional coronary angiography (CAG) for vessel diameter (r = 0.71), with a slight overestimation of 0.7 mm by VCATS. There were nine significant stenoses present of which six were correctly detected, three were missed and one false positive was present. VCATS is fast strategy for visualizing the major coronary artery branches and has the potential to detect significant stenoses in these branches.
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Affiliation(s)
- R J van Geuns
- Department of Cardiology, The Thorax Center, Erasmus University Medical Center, Rotterdam, The Netherlands.
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Abstract
BACKGROUND A new generation of subsecond multi-slice computed tomography (MSCT) scanners, which allow complete coronary coverage, are becoming widely available. We investigated the potential value of MSCT angiography in a range of coronary disorders. METHODS We studied 35 patients, including 11 who had undergone percutaneous transluminal coronary angioplasty and four who had had coronary-artery bypass grafts, by both MSCT and conventional coronary angiography. After intravenous injection of a non-ionic contrast medium with high iodine content, the entire heart was scanned within a single breath-hold. The total examination time was no more than 20 min. The retrospective electrocardiographically gated reconstruction source images and three-dimensional reconstructed volumes were analysed by two investigators, unaware of the results of conventional angiography. FINDINGS In the 31 patients without previous coronary surgery, 173 (73%) of the 237 proximal and middle coronary segments were assessable. In the assessable segments, 17 of 21 significant stenoses (>50% reduction of vessel diameter) were correctly diagnosed. The non-assessable segments included four lesions. Misinterpretations were mainly the result of severe calcification of the vessel wall. Segments with implanted stents were poorly visualised, but stent patency could be assessed in all cases. Of the 17 segments of bypass grafts, 15 were assessable and four of five graft lesions were detected. Two cases of anomalous coronary anatomy could be visualised well. INTERPRETATION These preliminary data suggest that MSCT allows non-invasive imaging of coronary-artery stenoses and has potential to develop into a reliable clinical technique.
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Affiliation(s)
- K Nieman
- Department of Cardiology, Thoraxcenter, Rotterdam University Hospital, Netherlands
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13
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van Geuns RJ, Wielopolski PA, de Bruin HG, Rensing BJ, Hulshoff M, van Ooijen PM, de Feyter PJ, Oudkerk M. MR coronary angiography with breath-hold targeted volumes: preliminary clinical results. Radiology 2000; 217:270-7. [PMID: 11012456 DOI: 10.1148/radiology.217.1.r00oc01270] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To assess the clinical value of a magnetic resonance (MR) coronary angiography strategy involving a small targeted volume to image one coronary segment in a single breath hold for the detection of greater than 50% stenosis. MATERIALS AND METHODS Thirty-eight patients referred for elective coronary angiography were included. The coronary arteries were localized during single-breath-hold, three-dimensional imaging of the entire heart. MR coronary angiography was then performed along the major coronary branches with a double-oblique, three-dimensional, gradient-echo sequence. Conventional coronary angiography was the reference-standard method. RESULTS Adequate visualization was achieved with MR coronary angiography in 85%-91% of the proximal coronary arterial branches and in 38%-76% of the middle and distal branches. Overall, 187 (69%) of 272 segments were suitable for comparison between conventional and MR coronary angiography. The diagnostic accuracy of MR coronary angiography for the detection of hemodynamically significant stenoses was 92%; sensitivity, 68%; and specificity, 97%. The sensitivity in individual segments was 50%-77%, whereas the specificity was 94%-100%. CONCLUSION Adequate visualization of the major coronary arterial branches was possible in the majority of patients. The observed accuracy of MR coronary angiography for detection of hemodynamically significant coronary arterial stenosis is promising, but it needs to be higher before this modality can be used reliably in a clinical setting.
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Affiliation(s)
- R J van Geuns
- Departments of Cardiology, Thoraxcenter, and Radiology, Daniel den Hoed Kliniek, University Hospital Rotterdam, Groene Hilledijk 301, 3075 EA Rotterdam, the Netherlands.
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14
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van Geuns RJ, Oudkerk M, de Feyter PJ, Spitaels SE. Magnetic resonance angiography of a pulmonary artery stenosis late after cardiac surgery. Circulation 2000; 102:E71-2. [PMID: 10982553 DOI: 10.1161/01.cir.102.11.e71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- R J van Geuns
- Department of Cardiology, Thoraxcenter, University Hospital Rotterdam, Rotterdam, The Netherlands.
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Abstract
BACKGROUND Virtual reality techniques have recently been introduced into clinical medicine. This study examines the possibility of coronary artery fly-through using a dataset obtained by noninvasive coronary angiography with contrast-enhanced electron-beam computed tomography. METHODS AND RESULTS Ten patients were examined, and 40 to 60 transaxial tomograms (thickness, 1.5 mm; in-plane pixel dimensions, approximately 0.5x0.5 mm) were obtained after intravenous contrast injection. The datasets were processed on a graphics workstation using volume-rendering software. For fly-throughs, the contrast-enhanced lumen was made transparent and other tissue was made opaque. Then, key frames were selected in a path through the vessel, with software interpolation of frames between key frames. A typical movie contained 150 to 300 frames (10 to 15 key frames). Fly-throughs of coronary bypass grafts (n=3), left anterior descending arteries (LAD; n=6), and the intermediate branch (n=1) were reconstructed. Coronary calcifications were seen in 3 patients. The fly-through of the intermediate branch, the bypass grafts, and one of the LADs did not show any irregularities. In 2 cases, a stenosis was visible in the LAD; its presence was confirmed by conventional coronary angiography. CONCLUSIONS Recent developments in fast-volume rendering using special-purpose hardware in combination with noninvasive coronary angiography with electron beam computed tomography have provided the possibility of performing coronary artery fly-throughs.
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Affiliation(s)
- P M van Ooijen
- Department of Radiology and Thoraxcentre, University Hospital Rotterdam/Daniel, Rotterdam, The Netherlands.
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16
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Affiliation(s)
- B J Rensing
- Department of Cardiology, Thoraxcenter, Rotterdam, Netherlands.
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17
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Abstract
Coronary angiography (CA) is presently considered the gold standard for the assessment of the coronary arteries. However, the presence of ionizing radiation, its invasiveness and the small associated risk of morbidity prompted long ago the development of more patient-friendly imaging modalities. A promising technique, magnetic resonance imaging (MRI), has been regarded as the major modality in the coming decade. Although still in its infancy qualitatively, its flexibility and non-invasiveness opens the door for a comprehensive evaluation of the heart and the coronary arteries in one single sitting with high anatomical definition and excellent soft tissue contrast capabilities, double-oblique tomographic sections and the possibility to quantify an innumerable number of cardiovascular physiological parameters. Numerous ideas have been assessed, comprising breath-hold and free-breathing two-dimensional and three-dimensional measurements. New ongoing trials with intravascular contrast agents may provide for all these techniques the long-awaited essential boost for reliable magnetic resonance coronary angiography (MRCA). Introduction of parallel MRI acquisition techniques, such as simultaneous acquisition of spatial harmonics (SMASH) and sensitivity encoding (SENSE) may provide the speed enhancement required to shorten imaging time for all techniques explored to date.
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Affiliation(s)
- P A Wielopolski
- Department of Radiology, Daniel den Hoed Cancer Center, University Hospital Rotterdam, Groene Hilledijk 301, NL-3075EA Rotterdam, The Netherlands
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18
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Janssen M, Breburda CS, van Geuns RJ, Hermans WR, Klootwijk P, Bekkers JA, Roelandt JR. Images in Cardiovascular Medicine. Aberrant right subclavian artery mimics aortic dissection. Circulation 2000; 101:459-60. [PMID: 10653840 DOI: 10.1161/01.cir.101.4.459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- M Janssen
- Departments of Cardiology and Cardiopulmonary Surgery, Erasmus University Medical Center, Rotterdam, Netherlands.
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19
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Rensing BJ, Bongaerts AH, van Geuns RJ, van Ooijen PM, Oudkerk M, de Feyter PJ. In vivo assessment of three dimensional coronary anatomy using electron beam computed tomography after intravenous contrast administration. Heart 1999; 82:523-5. [PMID: 10490574 PMCID: PMC1760284 DOI: 10.1136/hrt.82.4.523] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Intravenous coronary angiography with electron beam computed tomography (EBCT) allows for the non-invasive visualisation of coronary arteries. With dedicated computer hardware and software, three dimensional renderings of the coronary arteries can be constructed, starting from the individual transaxial tomograms. This article describes image acquisition, postprocessing techniques, and the results of clinical studies. EBCT coronary angiography is a promising coronary artery imaging technique. Currently it is a reasonably robust technique for the visualisation and assessment of the left main and left anterior descending coronary artery. The right and circumflex coronary arteries can be visualised less consistently. Improvements in image acquisition and postprocessing techniques are expected to improve visualisation and diagnostic accuracy of the technique.
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Affiliation(s)
- B J Rensing
- Department of Cardiology, Thoraxcenter BD 416, Erasmus University Rotterdam, Dr Molewaterplein 40, 3015 GD Rotterdam, Netherlands
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20
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van Geuns RJ, de Bruin HG, Rensing BJ, Wielopolski PA, Hulshoff MD, van Ooijen PM, Oudkerk M, de Feyter PJ. Magnetic resonance imaging of the coronary arteries: clinical results from three dimensional evaluation of a respiratory gated technique. Heart 1999; 82:515-9. [PMID: 10490571 PMCID: PMC1760261 DOI: 10.1136/hrt.82.4.515] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Magnetic resonance coronary angiography is challenging because of the motion of the vessels during cardiac contraction and respiration. Additional challenges are the small calibre of the arteries and their complex three dimensional course. Respiratory gating, turboflash acquisition, and volume rendering techniques may meet the necessary requirements for appropriate visualisation. OBJECTIVE To determine the diagnostic accuracy of respiratory gated magnetic resonance imaging (MRI) for the detection of significant coronary artery stenoses evaluated with three dimensional postprocessing software. METHODS 32 patients referred for elective coronary angiography were studied with a retrospective respiratory gated three dimensional gradient echo MRI technique. Resolution was 1.9 x 1.25 x 2 mm. After manual segmentation three dimensional evaluation was performed with a volume rendering technique. RESULTS Overall 74% (range 50% to 90%) of the proximal and mid coronary artery segments were visualised with an image quality suitable for further analysis. Sensitivity and specificity for the detection of significant stenoses were 50% and 91%, respectively. CONCLUSIONS Volume rendering of respiratory gated MRI techniques allows adequate visualisation of the coronary arteries in patients with a regular breathing pattern. Significant lesions in the major coronary artery branches can be identified with a moderate sensitivity and a high specificity.
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Affiliation(s)
- R J van Geuns
- Department of Cardiology, Thoraxcenter, University Hospital Rotterdam, Dr Molewaterplein 40, 3015 GD Rotterdam, Netherlands.
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21
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van Geuns RJ, Wielopolski PA, de Bruin HG, Hulshoff MD, Oudkerk M, de Feyter PJ. Magnetic resonance imaging of the coronary arteries: imaging planes and resulting anatomy in two-dimensional imaging. Coron Artery Dis 1999; 10:525-31. [PMID: 10562922 DOI: 10.1097/00019501-199910000-00014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Magnetic-resonance imaging techniques use different imaging planes than does conventional coronary angiography to acquire longer segments of a coronary artery in a single tomographic slice. At first sight, these planes appear rather puzzling, because the coronary arteries are displayed in unfamiliar orientations. In this article we will review the existing methodology for obtaining the orientations for the proximal coronary arteries and describe the associated anatomical landmarks that can be seen. Additional orientations for the middle segment of the circumflex and distal right coronary artery are introduced. These orientations are used both in various acquisition techniques and for evaluation of three-dimensional data when using multiplanar reformatting.
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Affiliation(s)
- R J van Geuns
- Department of Cardiology, University Hospital Rotterdam, The Netherlands.
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22
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van Geuns RJ, Wielopolski PA, de Bruin HG, Rensing BJ, van Ooijen PM, Hulshoff M, Oudkerk M, de Feyter PJ. Magnetic resonance imaging of the coronary arteries: techniques and results. Prog Cardiovasc Dis 1999; 42:157-66. [PMID: 10555116 DOI: 10.1016/s0033-0620(99)70015-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Recently a new noninvasive imaging technique, magnetic resonance imaging (MRI) has been developed that has the potential to assess the coronary arteries. MRI of the coronary arteries is a challenging task because of the motion of the vessels during cardiac contraction and the motion of the heart with respiration. Several two-dimensional and three-dimensional acquisition techniques have been developed to overcome these problems. In this article we will describe different conventional MR techniques such as spin-echo and gradient-echo imaging. Also, we will describe new developments in MRI as ultrafast breathhold techniques using echo planar imaging or targeted volume scanning. Other new developments are respiratory gating techniques with or without respiratory motion correction. Finally, we will review the results of these techniques in the detection of coronary artery bypass graft patency, coronary artery stenosis, and the evaluation of coronary artery anomalies.
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Affiliation(s)
- R J van Geuns
- Department of Cardiology, Thoraxcenter, Dr Daniel den Hoedkliniek, University Hospital Rotterdam, The Netherlands.
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Abstract
Magnetic resonance imaging (MRI) is a noninvasive imaging technique that is becoming more and more important in clinical cardiology. Physicians must understand the basic principles of MRI before reliable use in practice is possible. Therefore, we will give an introduction to basic MRI principles necessary to understand the difficulties of cardiac MRI. First the generation of a signal by the combination of a strong magnetic field, radiofrequency pulses, and temporary changes in the magnetic field is explained. Then, the processes of localization of different points in an image, resolution, and signal-to-noise ratio are highlighted. Finally, the influence of tissue characteristics such as T1 and T2 on the contrast of an image are discussed.
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Affiliation(s)
- R J van Geuns
- Department of Cardiology, Thoraxcenter, Dr Daniel den Hoedkliniek, University Hospital Rotterdam, The Netherlands.
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24
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Abstract
Intravenous coronary angiography with electron beam computed tomography (EBCT) allows for the noninvasive visualisation of coronary arteries. With dedicated computer hardware and software, three-dimensional renderings of the coronary arteries, veins, and other cardiac structures can be constructed from the individual transaxial tomograms. Interest in this technique is growing, and recently a number of clinical studies have been published comparing EBCT coronary angiography with conventional cine-coronary angiography. In this article, image acquisition, postprocessing techniques, and the results of recently published clinical studies are discussed. EBCT coronary angiography is a promising imaging technique of coronary arteries. Currently, it is a reasonably robust technique for the visualization and assessment of the left main and left anterior descending coronary artery. However, at the moment a relatively high proportion of the right and circumflex coronary angiograms are noninterpretable. Improvements in image acquisition and postprocessing techniques are expected to improve visualization and diagnostic accuracy of the technique.
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Affiliation(s)
- B J Rensing
- Department of Cardiology, Thoraxcenter, Dr Daniel den Hoed Kliniek, University Hospital Rotterdam, The Netherlands.
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25
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van Geuns RJ, Wielopolski PA, Rensing BJ, van Ooijen PM, Oudkerk M, de Feyter PJ. Magnetic resonance imaging of the coronary arteries: anatomy of the coronary arteries and veins in three-dimensional imaging. Coron Artery Dis 1999; 10:261-7. [PMID: 10376205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Magnetic resonance imaging of coronary arteries will visualize, besides the arteries, the myocardium, blood in the cavities and cardiac veins. This will hamper the application of projectional visualization techniques such as those used in conventional coronary angiography. Volume rendering, a different visualization technique, can be used to create a three-dimensional impression of a magnetic resonance data set on a two-dimensional surface. In this article, we will review the volume-rendering technique and anatomy of the coronary arteries and veins in the obtained images. Also we will discuss the relation between arteries and veins and the possible sites of confusion.
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Affiliation(s)
- R J van Geuns
- Department of Cardiology, University Hospital Rotterdam, The Netherlands.
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Rensing BJ, Bongaerts A, van Geuns RJ, van Ooijen P, Oudkerk M, de Feyter PJ. Intravenous coronary angiography by electron beam computed tomography: a clinical evaluation. Circulation 1998; 98:2509-12. [PMID: 9843455 DOI: 10.1161/01.cir.98.23.2509] [Citation(s) in RCA: 95] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND -Noninvasive detection of coronary stenoses with electron beam CT (EBCT) after intravenous injection of contrast medium has recently emerged. We sought to determine the diagnostic accuracy of EBCT angiography in the clinical setting using conventional coronary angiography as the "gold standard." METHODS AND RESULTS Thirty-seven patients (30 men) were investigated. After intravenous injection of 150 mL of contrast medium, 40 to 60 consecutive transaxial tomograms, covering the proximal and middle parts of the coronary arteries, were obtained with ECG triggering at end diastole during breath-holding. Three-dimensional reconstructions of the proximal and middle parts of the arteries were compared with the conventional angiograms. Of the 259 proximal and middle coronary segments, 211 (81%) were analyzable by EBCT. Of the left anterior descending coronary artery (LAD) segments, 95% were assessable. Right coronary artery (RCA) and left circumflex artery (LCx) segments were assessable in 66% and 76%, respectively. Overall sensitivity and specificity to detect a >50% diameter stenosis were 77% and 94%, respectively. This was 82% and 92% for the LAD, 60% and 97% for the RCA, and 83% and 89% for the LCx (all figures based on assessable lesions). CONCLUSIONS Intravenous EBCT coronary angiography is a promising coronary imaging technique. The technique is not yet robust enough to be an alternative to conventional coronary angiography. It can detect and rule out significant coronary artery disease of the left main proximal and mid portions of the LAD with good accuracy.
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Abstract
PURPOSE To illustrate a new concept for fast coronary artery screening with breath-hold volume targeted magnetic resonance (MR) imaging. MATERIALS AND METHODS Ten volunteers and 25 patients were imaged at a field strength of 1.5 T with an MR system with phased-array-coil reception and capable of echo-planar imaging. End-expiration breath-hold volume localization of the entire heart was performed with three-dimensional (3D) multishot segmented echo-planar imaging in 16-22 heartbeats. Interaction with a multiplaner reformation platform provided the optimal double-oblique volumes necessary to target seven coronary artery segments. Each segment was evaluated with 24-mm-thick volumes and breath holds at end expiration and magnetization transfer-enhanced 3D turbo fast low-angle shot imaging in 21 heartbeats. An intravascular contrast agent was used in eight patients to improve blood-myocardium contrast for the heart volume localizer acquisitions. RESULTS The entire coronary tree was consistently covered in fewer than 13 breath holds. The scheme was successful in all volunteers and in 22 patients who could achieve adequate breath hold. With end-expiration acquisitions, the prescribed 24-mm-thick volumes were reproducible for all coronary segments in all cooperative subjects. CONCLUSION Despite its status as the indisputable standard of reference for the detection of coronary artery disease, conventional coronary angiography remains costly and highly invasive, with associated risks of major complications, including stroke and death. Breath-hold volume targeted acquisitions permit rapid localization and coverage of the entire coronary tree with adequate resolution for evaluating the coronary arteries.
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Affiliation(s)
- P A Wielopolski
- Department of Radiology, Thorax Center, University Hospital Rotterdam, The Netherlands
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Abstract
Conventional coronary angiography (CA) is the standard of excellence for the evaluation of coronary artery disease. However, non-invasive imaging modalities have developed that can play an important clinical role in the diagnosis. Magnetic resonance imaging (MRI) can offer a comprehensive evaluation of the heart and the coronary arteries by virtue of its high soft tissue contrast capabilities, double-oblique tomographic sections and the possibility of quantifying physiological parameters without need of ionizing radiation. Magnetic resonance coronary arteriography (MRCA) using breath-hold and free-breathing techniques has been investigated but is still in the experimental phase; its precise role for the assessment of coronary stenosis must still be identified. Nonetheless, MRCA has proven clinically relevant in determining the course of anomalous coronary arteries and the patency of coronary artery bypass grafts. Novel intravascular contrast agents promise faster coverage of the cardiac anatomy and may provide a long-awaited boost for MRCA. Contrast-enhanced electron-beam computed tomography (EBT), another competing imaging modality, is now being subjected to widespread evaluation following initially encouraging results.
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Affiliation(s)
- P A Wielopolski
- Department of Radiology, Daniel den Hoed Cancer Center, University Hospital Rotterdam, 301 Groene Hilledijk, 3075 EA Rotterdam, The Netherlands
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