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Stent sizing by coronary CT angiography compared with optical coherence tomography
Brian Ko1, Hirofumi Ohashi2, Takuya Mizukami3
1Monash Cardiovascular Research Centre, Monash University and Monash Heart, Monash Health, Clayton, Victoria, Australia.
Insights
Coronary CT angiography (CCTA) accurately measures vessel diameter for stent sizing in percutaneous coronary intervention (PCI). CCTA shows substantial agreement with optical coherence tomography (OCT), aiding PCI planning.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
Background:
- Coronary CT angiography (CCTA) is established for coronary artery disease (CAD) diagnosis.
- Its role in guiding percutaneous coronary interventions (PCI) and stent sizing remains unclear.
Purpose of the Study:
- To evaluate the accuracy of CCTA in assessing reference vessel diameter for stent sizing.
- To compare CCTA-derived stent size with optical coherence tomography (OCT) measurements.
Main Methods:
- Sub-analysis of the Precise Percutaneous Coronary Intervention Plan (P3) study.
- Compared CCTA and OCT assessments in 65 coronary vessels.
- Analyzed agreement using Kappa statistics, Passing-Bablok regression, and Bland-Altman methods.
Main Results:
- CCTA and OCT showed similar distal reference lumen diameters (2.75 ± 0.53 mm vs. 2.72 ± 0.55 mm).
- No significant proportional or systematic differences were found between CCTA and OCT.
- Substantial agreement (Cohen's Kappa 0.74) was observed between CCTA- and OCT-guided stent sizes.
Conclusions:
- CCTA accurately assesses reference vessel diameter for stent sizing.
- CCTA-based stent sizing demonstrates substantial agreement with OCT.
- CCTA can aid in percutaneous coronary intervention planning and stent selection.
Background:
Coronary CT angiography (CCTA) is well-established for diagnosis and stratification of coronary artery disease (CAD). Its usefulness in guiding percutaneous coronary interventions (PCI) and stent sizing is unknown.
Methods:
This is a sub-analysis of the Precise Percutaneous Coronary Intervention Plan (P3) study (NCT03782688). We analyzed 65 vessels with matched CCTA and pre-PCI optical coherence tomography (OCT) assessment. The CCTA-guided stent size was defined by the mean distal reference lumen diameter rounded up to the nearest stent diameter. The OCT lumen-guided stent size was the mean distal reference lumen diameter rounded to the closest stent diameter. The agreement on stent diameters was determined with Kappa statistics, Passing-Bablok regression analysis, and the Bland-Altman method.
Results:
The distal reference lumen diameter by CCTA and OCT were 2.75 ± 0.53 mm and 2.72 ± 0.55 mm (mean difference 0.06, limits of agreement -0.7 to 0.82). There were no proportional or systematic differences (coefficient A 1.06, 95% CI 0.84 to 1.3 and coefficient B -0.22, 95% CI -0.83 to 0.36) between methods. The agreement between the CCTA and OCT stent size was substantial (Cohen's weighted Kappa 0.74, 95% CI 0.64 to 0.85). Compared to OCT stent diameter, CCTA stent size was concordant in 52.3% of the cases; CCTA overestimated stent size in 20.0% and underestimated in 27.7%.
Conclusion:
CCTA accurately assessed the reference vessel diameter used for stent sizing. CCTA-based stent sizing showed a substantial agreement with OCT. CCTA allows for PCI planning and may aid in selecting stent diameter.
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