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Improved Registration of 3D CT Angiography with X-ray Fluoroscopy for Image Fusion During Transcatheter Aortic Valve Implantation
Published on: June 3, 2018
Coronary Computed Tomography Angiography for Percutaneous Coronary Intervention: Initial United States Experience
Pedro E P Carvalho1, Joao L Cavalcante1,2, John Lesser2
1Center for Coronary Artery Disease, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA.
Background:
Coronary computed tomography angiography (CCTA) and CCTA-derived fractional flow reserve (FFRCT) based virtual percutaneous coronary intervention (PCI) can facilitate pre-procedural planning but there are limited clinical data.
Methods:
Observational cohort study of consecutive patients undergoing CCTA-guided PCI with the use of the FFRCT-based virtual planner, which conjointly with CCTA enables pre-procedural planning including guide catheter selection, optimal fluoroscopic angles, stent length based on predicted post-PCI FFRCT, as well as plaque and calcium characterization. We also assessed the correlation between FFRCT and invasive FFR.
Results:
Between April 2023 and January 2025, CCTA-guided PCI was performed in 52 patients (40% female, mean age 70 ± 9 years, 23% acute coronary syndrome) and 59 PCIs. The left anterior descending artery was the most common target vessel (51%). The median baseline FFRCT was 0.70 (interquartile range [IQR] 0.62-0.74) and the median calcium score was 590 (IQR 189-1169). Intravascular imaging was used in all cases (83% intravascular ultrasound, 17% optical coherence tomography) for stent sizing and/or post-PCI stent assessment. Thirteen PCIs (22%) required advanced calcium modification (11 intravascular lithotripsy and 2 atherectomy). Median procedural time was 88 (IQR 70-108) min, fluoroscopy time was 18.4 (13.3-26.4) min, contrast volume was 140 (125-180) mL, and air kerma radiation dose was 1.24 (0.82-1.96) Gy. Technical success was 100%. Median post-PCI invasive FFR was 0.92 [0.89-0.95]. Pre- and post-PCI invasive FFR correlated well with FFRCT (R = 0.74; p < 0.001).
Conclusion:
CCTA-guided PCI with FFRCT based virtual pre-procedural planning was associated with excellent clinical results, with predicted post-PCI FFRCT associated with observed post-PCI invasive FFR.
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