Optimal Fluoroscopic Projections of Coronary Ostia and Bifurcations Defined by Computed Tomographic Coronary Angiography
- PMID: 33153569
- DOI: 10.1016/j.jcin.2020.06.042
Optimal Fluoroscopic Projections of Coronary Ostia and Bifurcations Defined by Computed Tomographic Coronary Angiography
Abstract
Objectives: The aim of this study was to define the optimal fluoroscopic viewing angles of both coronary ostia and important coronary bifurcations by using 3-dimensional multislice computed tomographic data.
Background: Optimal fluoroscopic projections are crucial for coronary imaging and interventions. Historically, coronary fluoroscopic viewing angles were derived empirically from experienced operators.
Methods: In this analysis, 100 consecutive patients who underwent computed tomographic coronary angiography (CTCA) for suspected coronary artery disease were studied. A CTCA-based method is described to define optimal viewing angles of both coronary ostia and important coronary bifurcations to guide percutaneous coronary interventions.
Results: The average optimal viewing angle for ostial left main stenting was left anterior oblique (LAO) 37°, cranial (CRA) 22° (95% confidence interval [CI]: LAO 33° to 40°, CRA 19° to 25°) and for ostial right coronary stenting was LAO 79°, CRA 41° (95% CI: LAO 74° to 84°, CRA 37° to 45°). Estimated mean optimal viewing angles for bifurcation stenting were as follows: left main: LAO 0°, caudal (CAU) 49° (95% CI: right anterior oblique [RAO] 8° to LAO 8°, CAU 43° to 54°); left anterior descending with first diagonal branch: LAO 11°, CRA 71° (95% CI: RAO 6° to LAO 27°, CRA 66° to 77°); left circumflex bifurcation with first marginal branch: LAO 24°, CAU 33° (95% CI: LAO 15° to 33°, CAU 25° to 41°); and posterior descending artery and posterolateral branch: LAO 44°, CRA 34° (95% CI: LAO 35° to 52°, CRA 27° to 41°).
Conclusions: CTCA can suggest optimal fluoroscopic viewing angles of coronary artery ostia and bifurcations. As the frequency of use of diagnostic CTCA increases in the future, it has the potential to provide additional information for planning and guiding percutaneous coronary intervention procedures.
Keywords: computed tomography; coronary angiography; coronary arteries; fluoroscopy; percutaneous coronary intervention.
Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Conflict of interest statement
Author Relationship With Industry Dr. Kočka was supported by the European Commission: 1) Operational Programme: Research, Development and Education, Summons No. 17 International Mobility of Researchers (CZ.02.2.69/0.0/0.0/16_027/0008495); 2) Operational Programme: Research, Development and Education, project INTERCARDIS (CZ.02.1.01/0.0/0.0/16_026/0008388); and by Charles University Research Centre (UNCE/MED/002). Drs. Thériault-Lauzier and Piazza have been consultants for Circle Cardiovascular Imaging. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Comment in
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The Use of CTCA for Planning PCI: Using the 3D Coronary Tree Information.JACC Cardiovasc Interv. 2020 Nov 9;13(21):2571-2573. doi: 10.1016/j.jcin.2020.08.015. JACC Cardiovasc Interv. 2020. PMID: 33153570 No abstract available.
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