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Multi-detector row CT versus coronary angiography: preoperative evaluation before totally endoscopic coronary artery
Christopher Herzog1, Selami Dogan, Thomas Diebold
1Institute for Diagnostic and Interventional Radiology, J. W. Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany. c.herzog@em.uni-frankfurt.de
Insights
Multi-detector row CT offers valuable preoperative insights for coronary artery bypass grafting, aiding in surgical planning. This advanced imaging technique provides detailed information on coronary anatomy and plaque composition, enhancing procedural outcomes.
Area of Science:
- Cardiovascular Imaging
- Medical Diagnostics
- Surgical Planning
Background:
- Minimally invasive cardiac surgery, including totally endoscopic coronary artery bypass grafting (TECAB), demands precise preoperative anatomical assessment.
- Traditional coronary angiography may not fully delineate all aspects of coronary anatomy relevant to bypass grafting.
Purpose of the Study:
- To evaluate the utility of multi-detector row computed tomography (CT) in the preoperative assessment of patients undergoing TECAB.
- To correlate multi-detector row CT findings with coronary angiography and intraoperative surgical data.
Main Methods:
- Thirty-six patients underwent multi-detector row CT and coronary angiography prior to TECAB.
- Both imaging modalities were assessed for coronary artery visualization, stenosis detection, plaque characterization, and anastomosis site suitability.
- CT data was compared against coronary angiography and surgical outcomes.
Main Results:
- Multi-detector row CT visualized a high percentage of surgical-relevant coronary segments (79.4%) and all coronary segments (80.4%).
- CT demonstrated superior detection of calcified plaques (100% vs. 83%) and better identification of coronary segment bridging compared to coronary angiography.
- The technique accurately identified suitable distal bypass anastomosis sites (76%).
Conclusions:
- Multi-detector row CT provides comprehensive information regarding coronary target sites and atherosclerotic burden.
- It serves as an ideal complementary tool for planning complex minimally invasive coronary artery bypass grafting procedures.
Purpose:
To assess multi-detector row spiral computed tomography (CT) for preoperative evaluation of patients undergoing totally endoscopic coronary artery bypass grafting and to correlate the data with coronary angiographic and intraoperative findings.
Materials And Methods:
Thirty-six patients preoperatively underwent multi-detector row CT (4 x 1-mm collimation, pitch of 1.5, 500-msec rotation time, retrospective electrocardiographic gating, 1.25-mm effective section thickness) and coronary angiography. Assessment criteria for both techniques were visibility and cardiac course of coronary arteries, localization and degree of stenoses, composition of atherosclerotic plaques, and vascular diameter at anastomosis site. Site for distal bypass anastomosis was recommended. Results at multi-detector row CT were calculated relative to results at coronary angiography and surgery.
Results:
Multi-detector row CT properly displayed 79.4% (154 of 194) of all surgical relevant coronary segments and 80.4% (434 of 540) of all coronary segments. For coronary angiography, ratios of 88.7% (172 of 194) and 94.6% (511 of 540), respectively, were observed. For detection of calcified plaques, multi-detector row CT results exceeded those at coronary angiography by a difference of 17% (18 of 18 [100%] compared with 15 of 18 [83%]). Hemodynamically relevant stenoses were identified with multi-detector row CT in 76% (42 of 55) of cases. Bridging of coronary segments through either myocardium (four of five) or epicardial fat (two of three) was better identified at multi-detector row CT than it was at coronary angiography (one of five compared with zero of three, respectively). At multi-detector row CT, 76% (28 of 37) of all distal bypass touchdown segments were identified, but at coronary angiography, only 70% (26 of 37) were identified.
Conclusion:
Multi-detector row CT provides extended information about coronary target site and therefore should be regarded as an ideal additive planning tool for complex minimally invasive procedures such as totally endoscopic coronary artery bypass grafting or minimally invasive direct coronary artery bypass grafting.
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