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Improved Registration of 3D CT Angiography with X-ray Fluoroscopy for Image Fusion During Transcatheter Aortic Valve Implantation
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Vascular Assessment for Transcatheter Aortic Valve Replacement: Intravascular Ultrasound Compared With Computed

Essa Essa, Nader Makki, Peter Bittenbender

  • 1Department of Cardiovascular Medicine, The Ohio State Wexner Medical Center, 410 W. 10th Ave, 1 Maloney Building, Columbus, OH 43210 USA. Scott.Lilly@osumc.edu.

The Journal of Invasive Cardiology
|December 7, 2016
PubMed

Insights

Intravascular ultrasound (IVUS) is a viable alternative to computed tomography angiography (CTA) for assessing arteries before transcatheter aortic valve replacement (TAVR), offering comparable accuracy with reduced contrast and radiation exposure.

Area of Science:

  • Cardiovascular Imaging
  • Interventional Cardiology
  • Vascular Assessment

Background:

  • Accurate assessment of femoral and iliac arteries is crucial for transcatheter aortic valve replacement (TAVR) planning.
  • Computed tomography angiography (CTA) is the standard but has limitations for vascular evaluation.
  • Predicting vascular complications and determining femoral access candidacy requires precise arterial imaging.

Purpose of the Study:

  • To compare the accuracy and safety of intravascular ultrasound (IVUS) against CTA for pre-TAVR iliofemoral artery assessment.
  • To evaluate IVUS as an alternative or adjunct to CTA in TAVR candidates.

Main Methods:

  • Fifteen patients undergoing pre-TAVR evaluation underwent coronary angiography, aortography, iliofemoral arteriography, and IVUS.
  • Vascular parameters including tortuosity, minimum lumen diameter, and cross-sectional area were measured.
  • IVUS findings were compared with CTA and invasive angiography results.

Main Results:

  • Strong correlation was observed between IVUS and CTA for minimum luminal diameter (r=0.62).
  • CTA and invasive angiography showed strong concordance for tortuosity assessment (r=0.75).
  • IVUS-guided assessment resulted in significantly lower contrast utilization (29 cc vs 100 cc) and radiation exposure (527 mGy vs 998 mGy) compared to CTA.

Conclusions:

  • Intravascular ultrasound (IVUS) is a viable alternative to CTA for pre-TAVR iliofemoral artery assessment, demonstrating comparable accuracy.
  • IVUS offers potential benefits of reduced contrast and radiation exposure.
  • IVUS serves as a valuable adjunct to CTA for challenging cases, such as borderline access diameters or CTA artifacts.
Abstract

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