Brian B Ghoshhajra1, Richard A P Takx1, Luke L Stone2, Erin E Girard3, Emmanouil S Brilakis4, William L Lombardi5, Robert W Yeh2, Farouc A Jaffer6. 1. Cardiac MR PET CT Program, Massachusetts General Hospital, Department of Radiology and Division of Cardiology, Harvard Medical School, Boston, MA, USA. 2. Cardiac Cathetrization Laboratory, Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States. 3. Siemens Healthcare, Princeton, NJ, USA. 4. Cardiology Division, Dallas VA Medical Center and UT Southwestern Medical Center, Dallas, TX, USA. 5. Cardiology Division, University of Washington, Seattle, WA, USA. 6. Cardiac Cathetrization Laboratory, Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States. fjaffer@mgh.harvard.edu.
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.
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.
Authors: Emmanouil S Brilakis; J Aaron Grantham; Stéphane Rinfret; R Michael Wyman; M Nicholas Burke; Dimitri Karmpaliotis; Nicholas Lembo; Ashish Pershad; David E Kandzari; Christopher E Buller; Tony DeMartini; William L Lombardi; Craig A Thompson Journal: JACC Cardiovasc Interv Date: 2012-04 Impact factor: 11.195
Authors: Georgios Sianos; Gerald S Werner; Alfredo R Galassi; Michail I Papafaklis; Javier Escaned; David Hildick-Smith; Evald Høj Christiansen; Anthony Gershlick; Mauro Carlino; Angelos Karlas; Nikolaos V Konstantinidis; Salvatore D Tomasello; Carlo Di Mario; Nicolaus Reifart Journal: EuroIntervention Date: 2012-05-15 Impact factor: 6.534
Authors: Mauro Carlino; Caroline J Magri; Barry F Uretsky; Emmanouil S Brilakis; Simon Walsh; James C Spratt; Colm Hanratty; J Aaron Grantham; Stéphane Rinfret; Craig A Thompson; William L Lombardi; Alfredo R Galassi; George Sianos; Azeem Latib; Roberto Garbo; Dimitri Karmpaliotis; David E Kandzari; Antonio Colombo Journal: Catheter Cardiovasc Interv Date: 2014-11-22 Impact factor: 2.692
Authors: Loes P Hoebers; Bimmer E Claessen; Joelle Elias; George D Dangas; Roxana Mehran; José P S Henriques Journal: Int J Cardiol Date: 2015-03-17 Impact factor: 4.164
Authors: Andreas Rolf; Gerald S Werner; Annika Schuhbäck; Johannes Rixe; Helge Möllmann; Holger M Nef; Constantin Gundermann; Christoph Liebetrau; Gabriele A Krombach; Christian W Hamm; Stephan Achenbach Journal: Int J Cardiovasc Imaging Date: 2013-06-23 Impact factor: 2.357
Authors: Maksymilian P Opolski; Bríain Ó Hartaigh; Daniel S Berman; Matthew J Budoff; Stephan Achenbach; Mouaz Al-Mallah; Daniele Andreini; Filippo Cademartiri; Hyuk-Jae Chang; Kavitha Chinnaiyan; Benjamin J W Chow; Martin Hadamitzky; Joerg Hausleiter; Gudrun Feuchtner; Yong-Jin Kim; Philipp A Kaufmann; Jonathon Leipsic; Erica Maffei; Gianluca Pontone; Gilbert Raff; Leslee J Shaw; Todd C Villines; James K Min Journal: Heart Date: 2015-06-15 Impact factor: 5.994
Authors: David E Kandzari; Sunil V Rao; Jeffrey W Moses; Vladimir Dzavik; Bradley H Strauss; Michael J Kutryk; Charles A Simonton; Jyotsna Garg; Yuliya Lokhnygina; G B John Mancini; Eunice Yeoh; Christopher E Buller Journal: JACC Cardiovasc Interv Date: 2009-02 Impact factor: 11.195
Authors: Peter Tajti; Iosif Xenogiannis; Dimitris Karmpaliotis; Khaldoon Alaswad; Farouc A Jaffer; M Nicholas Burke; Imre Ungi; Emmanouil S Brilakis Journal: Curr Cardiol Rep Date: 2018-10-22 Impact factor: 2.931