Lesion characteristics and coronary stent selection with computed tomographic coronary angiography: a pilot investigation comparing CTA, QCA and IVUS.

OBJECTIVE: The accurate assessment of a target coronary lesion and appropriate stent selection is important in ensuring procedural success during percutaneous coronary intervention (PCI). Though quantitative coronary angiography (QCA) and intravascular ultrasound (IVUS) are available, stent selection is most commonly performed by visual estimation alone. Computed tomographic coronary angiography (CTA) has been shown to correlate well with QCA and IVUS in the assessment of coronary stenoses and may also have a role in stent guidance.
MATERIALS AND METHODS: Patients awaiting elective PCI underwent CTA. Blinded observers assessed lesion characteristics using: CTA, QCA, IVUS and visual estimation. Luminal diameters, lesion lengths, ACC/AHA lesion types and CTA-suggested stent sizes were compared.
RESULTS: A total of 17 patients (26 lesions) were evaluated. There was good correlation between CTA and IVUS for luminal diameter and for lesion length (r = 0.86 and 0.71, respectively). Similarly, the inter-test variability between the two methods using the intra-class coefficient (ICC = 0.85) was similar to the inter-observer variability of IVUS (ICC = 0.90). The agreement between CTA and visual estimation for lesion type was good (K = 0.79) and was similar to the agreement between the two visual observers (K = 0.72). There was good correlation between CTA stent recommended and actual stent selected (diameter, r = 0.82; length, r = 0.64).
CONCLUSIONS: If CTA data is available prior to coronary angioplasty, the reporting of luminal size, length, and lesion type may assist the clinician with coronary stent selection.