Computed tomography (CT) can define optimal fluoroscopic views of coronary artery ostia and bifurcations, allowing for better planning and guiding for percutaneous coronary interventions (PCI) procedures, according to a study presented Thursday at the PCR e-Course.
Optimal fluoroscopic projections are vital for coronary imaging and ensuring excellent results when performing PCI. Historically, obtaining coronary fluoroscopic viewing angles were derived empirically from experienced operators. However, Viktor Kočka, MD, PhD, of McGill University Health Centre, Montreal, and co-authors sought to define the optimal fluoroscopic viewing angles of both coronary ostia and coronary bifurcations using three-dimensional multi-slice CT data.
The paper by Kočka and colleagues was simultaneously published online in JACC: Cardiovascular Interventions.
The authors studied 100 consecutive patients who underwent computed tomography coronary angiography (CTCA) for suspect coronary artery disease (CAD) a single a center. In addition, they described a CTCA-based method to define the optimal viewing angles of both coronary ostia and coronary bifurcations to guide PCIs.
Their analysis demonstrated that the average optimal viewing angles for ostial left main stenting were 37 degrees for the left anterior oblique (LAO) and 22 degrees for the cranial (CRA). For ostial right coronary stenting, the average optimal viewing angles were 79 degrees for the LAO and 41 degrees for the CRA.
The estimated mean optimal viewing angles for bifurcation stenting were as follows: left main – 0 degrees for the LAO and 49 degrees for the caudal (CAU); left anterior descending with first diagonal branch – 11 degrees for the LAO and 71 degrees for the CRA 71; left circumflex bifurcation with first marginal branch – 24 degrees for the LAO and 33 degrees for the CAU; and posterior descending artery and posterolateral branch – 44 degrees for the and 34 degrees for the CRA 34.
These findings, some of which the authors acknowledged are not practical, might modify standard coronary angiography projections.
Despite having the limitation of being a retrospective analysis with some interobserver variability, the study showed that CTCA can help suggest optimal fluoroscopic viewing angles of coronary artery ostia and bifurcations. As the frequency of use of diagnostic CTCA increases in the future, it has the potential to provide additional information for planning and guiding PCI procedures.
Future efforts should focus on studies assessing the agreement between predicted tomographic optimal viewing angles and invasive angiography and the impact this may have on clinical outcomes, the authors concluded.
Two authors of the manuscript, Pascal Theriault-Lauzier, MD, PhD, and Nicolo Piazza, MD, PhD, both of McGill University Health Centre, reported being consultants for Circle Cardiovascular Imaging Inc., Calgary, Alberta. Kočka was supported by grants from the European Commission.
PCR e-Course is the virtual meeting being held in place of the annual in-person EuroPCR congress, which was canceled because of the COVID-19 pandemic.
Kočka V, Theriault-Lauzier P, Xiong T-Y, et al. Optimal Fluoroscopic Projections of Coronary Ostia and Bifurcations Defined by Computed Tomography Coronary Angiography. JACC Cardiovasc Interv. 2020 Jun 25. https://doi.org/10.1016/j.jcin.2020.06.042