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Cone Beam Intraoperative Computed Tomography-based Image Guidance for Minimally Invasive Transforaminal Interbody Fusion
Published on: August 6, 2019
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Pre-procedural computed tomography predicts procedural complexity and complications in bidirectional rotational
Federico Migliore1, Raimondo Pittorru1, Vincenzo Tarzia1
1Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via N. Giustiniani 2, Padua 35121, Italy.
Summary
Pre-procedural cardiac CT accurately predicts complications during rotational mechanical transvenous lead extraction (TLE). Fibrosis length on CT is a key predictor of complicated and complex TLE procedures, aiding risk stratification.
Area of Science:
- Cardiology
- Medical Imaging
- Interventional Procedures
Background:
- Transvenous lead extraction (TLE) is technically challenging.
- Cardiac computed tomography (CT) aids pre-procedural assessment in TLE.
- The predictive role of CT for rotational mechanical TLE outcomes requires further definition.
Purpose of the Study:
- To determine if pre-procedural CT can predict complications and procedural complexity in rotational mechanical TLE.
- To assess the utility of CT imaging in planning TLE procedures.
- To identify anatomical features on CT that correlate with TLE outcomes.
Main Methods:
- Retrospective study of 115 patients undergoing rotational mechanical TLE.
- Pre-procedural contrast-enhanced CT with a dedicated lead extraction protocol was performed.
- Complicated (major complication, incomplete removal, snare use) and complex (snare or sheath use) procedures were evaluated using logistic regression and ROC analysis.
Main Results:
- Complicated procedures (20.9%) were independently associated with longest fibrosis length on CT (OR 1.1).
- Fibrosis length >40 mm predicted complicated procedures with high accuracy (AUC 0.92).
- Complex procedures (37.4%) were associated with fibrosis length, lead calcification, dwelling time, and heart failure; fibrosis length >30 mm predicted complexity (AUC 0.72).
Conclusions:
- Pre-procedural CT accurately identifies high-risk anatomical features like fibrosis length and calcifications.
- These CT findings independently predict complicated and complex rotational mechanical TLE.
- CT imaging integration into procedural planning can improve individualized risk stratification for TLE.
