Computed tomography angiography versus angiography for guiding percutaneous coronary interventions in bifurcation
Rafal Wolny1, Jerzy Pregowski1, Mariusz Kruk2
1Department of Interventional Cardiology and Angiology, Institute of Cardiology, 42 Alpejska St, 04-628 Warsaw, Poland.
Insights
Coronary computed tomography angiography (CTA) improves percutaneous coronary intervention (PCI) for bifurcation lesions by reducing stent use and overlap, while maintaining similar immediate outcomes compared to traditional angiography.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Percutaneous coronary intervention (PCI) for bifurcation lesions presents unique challenges.
- The role of coronary computed tomography angiography (coronary CTA) in guiding PCI for these complex lesions remains underexplored.
- Existing data lacks insight into the impact of incorporating coronary CTA into the planning of bifurcation PCI.
Purpose of the Study:
- To evaluate the impact of coronary CTA-assisted planning on the outcomes of percutaneous coronary interventions (PCI) in patients with stable coronary artery disease and bifurcation lesions.
- To compare procedural characteristics, immediate angiographic results, and safety outcomes between coronary CTA-guided PCI and conventional angiography-guided PCI.
Main Methods:
- A randomized controlled trial comparing coronary CTA and angiography (CTA group) versus angiography alone (CA group) for planning elective bifurcation PCI.
- Patients were randomized 1:1 to either planning strategy.
- Primary endpoint was immediate angiographic result; secondary endpoints included procedural characteristics and side branch (SB) fractional flow reserve (FFR). Safety outcomes included periprocedural myocardial infarction, contrast use, and radiation dose.
Main Results:
- No significant differences were observed in postprocedural lumen diameters, SB compromise/occlusion, or mean SB FFR between the CTA and CA groups.
- The CTA group demonstrated significantly less frequent use of two or more stents (18% vs. 43%, p=0.01), primarily due to reduced main branch (MB) 2-stent overlap.
- The CTA group utilized the proximal optimization technique more frequently (44% vs. 21%, p=0.018).
Conclusions:
- Coronary CTA-assisted PCI for bifurcation lesions yields comparable immediate angiographic results to conventional angiography.
- CTA guidance is associated with a trend towards single-stent strategies, characterized by increased use of proximal optimization technique and reduced stent overlap.
- The study suggests CTA can optimize PCI procedural strategies for bifurcation lesions, potentially leading to less complex interventions.
Background:
There is no data on the impact of coronary computed tomography angiography (coronary CTA), as an addition to angiography, on the outcomes of percutaneous coronary interventions (PCI) in bifurcation lesions.
Methods:
Patients with stable coronary artery disease scheduled for elective bifurcation PCI were randomized 1:1 to planning the procedure based on coronary CTA and angiography (CTA group) or angiography alone (CA group). The primary efficacy endpoint was the immediate angiographic result. Secondary efficacy endpoints were: a) procedural characteristics and b) postprocedural fractional flow reserve (FFR) in the side branch (SB) in a subgroup of patients. Safety outcomes were: a) periprocedural myocardial infarction, b) contrast use and c) radiation dose.
Results:
PCI of 45 lesions in the CTA group and 47 lesions in the CA group was performed. Postprocedural lumen diameters in the main branch (MB) and SB, frequency of SB compromise or occlusion and mean SB FFR values were not different between study groups. Two or more stents were implanted less frequently in the CTA group than in the CA group (18% vs. 43%, p = 0.01). This difference was driven by less frequent MB 2-stent overlap in the CTA group (7 vs. 21%, p = 0.046) and numerically less SB stenting (11% vs. 21%, p = 0.07). Proximal optimization technique was used more frequently in the CTA group (44% vs. 21%, p = 0.018).
Conclusions:
CTA-assisted bifurcation PCI leads to similar immediate results compared with angiography alone, however is associated with higher use of single-stent procedures with proximal optimization, less frequent 2-stent overlap and less SB stenting.
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