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Real-time fusion of coronary CT angiography with x-ray fluoroscopy during chronic total occlusion PCI

  • Interventional
  • Published:
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Abstract

Objectives

The purpose of this study was to demonstrate the feasibility of real-time fusion of coronary computed tomography angiography (CTA) centreline and arterial wall calcification with x-ray fluoroscopy during chronic total occlusion (CTO) percutaneous coronary intervention (PCI).

Methods

Patients undergoing CTO PCI were prospectively enrolled. Pre-procedural CT scans were integrated with conventional coronary fluoroscopy using prototype software. We enrolled 24 patients who underwent CTO PCI using the prototype CT fusion software, and 24 consecutive CTO PCI patients without CT guidance served as a control group.

Results

Mean age was 66 ± 11 years, and 43/48 patients were men. Real-time CTA fusion during CTO PCI provided additional information regarding coronary arterial calcification and tortuosity that generated new insights into antegrade wiring, antegrade dissection/reentry, and retrograde wiring during CTO PCI. Overall CTO success rates and procedural outcomes remained similar between the two groups, despite a trend toward higher complexity in the fusion CTA group.

Conclusions

This study demonstrates that real-time automated co-registration of coronary CTA centreline and calcification onto live fluoroscopic images is feasible and provides new insights into CTO PCI, and in particular, antegrade dissection reentry-based CTO PCI.

Key Points

• Real-time semi-automated fusion of CTA/fluoroscopy is feasible during CTO PCI.

• CTA fusion data can be toggled on/off as desired during CTO PCI

• Real-time CT calcium and centreline overlay could benefit antegrade dissection/reentry-based CTO PCI.

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Abbreviations

ADR:

Antegrade dissection/reentry

CTA:

Coronary CT angiography

CT:

Computed tomography

CTO:

Chronic total occlusion

MACE:

Major adverse cardiac events

MPR:

Multiplanar reformat

PCI:

Percutaneous coronary intervention

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Acknowledgments

The scientific guarantor of this publication is Farouc A. Jaffer. The authors of this manuscript declare relationships with the following companies:

Dr. Girard is an employee of Siemens Healthcare. Dr Brilakis received consulting honoraria/speaker fees from St Jude Medical, Terumo, Asahi, Abbott Vascular, Somahlution, Elsevier, and Boston Scientific and research grant from InfraRedx; Dr. Brilakis’s spouse is an employee of Medtronic. Dr. Lombardi has consulted for Boston Scientific, Abbott Vascular, and Asahi Intecc; Dr Lombardi’s spouse is an employee of Spectranetics. Dr. Yeh has consulted for Abbott Vascular and Boston Scientific. Dr. Ghoshhajra has consulted for Siemens Healthcare and Medtronic. Dr. Jaffer receives research funding from Siemens Medical Solutions, Kowa, Canon, and the National Institutes of Health, and has consulted for Boston Scientific and Abbott Vascular. All remaining authors have no relevant conflicts of interest.

This work was supported in part by a research grant from Siemens Medical Solutions. One of the authors has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: prospective, case-control study, performed at one institution.

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    Authors and Affiliations

    1. Cardiac MR PET CT Program, Massachusetts General Hospital, Department of Radiology and Division of Cardiology, Harvard Medical School, Boston, MA, USA

      Brian B. Ghoshhajra & Richard A. P. Takx

    2. Cardiac Cathetrization Laboratory, Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States

      Luke L. Stone, Robert W. Yeh & Farouc A. Jaffer

    3. Siemens Healthcare, Princeton, NJ, USA

      Erin E. Girard

    4. Cardiology Division, Dallas VA Medical Center and UT Southwestern Medical Center, Dallas, TX, USA

      Emmanouil S. Brilakis

    5. Cardiology Division, University of Washington, Seattle, WA, USA

      William L. Lombardi

    Authors
    1. Brian B. Ghoshhajra
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    8. Farouc A. Jaffer
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    Correspondence to Farouc A. Jaffer.

    Additional information

    Brian B. Ghoshhajra and Richard A. P. Takx contributed equally to this work.

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    Ghoshhajra, B.B., Takx, R.A.P., Stone, L.L. et al. Real-time fusion of coronary CT angiography with x-ray fluoroscopy during chronic total occlusion PCI. Eur Radiol 27, 2464–2473 (2017). https://doi.org/10.1007/s00330-016-4599-5

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    • DOI: https://doi.org/10.1007/s00330-016-4599-5

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