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A Novel Method for the Analysis of Bifurcation Lesions

A Novel Method for the Analysis of Bifurcation Lesions. Gerhard Koning 1 , Joan Tuinenburg 1 , Lucien de Mos 2 , Andrei Rares 1 , Hans Reiber 1 , Yves Louvard 3

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A Novel Method for the Analysis of Bifurcation Lesions

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  1. A Novel Method for the Analysis of Bifurcation Lesions Gerhard Koning1, Joan Tuinenburg1,Lucien de Mos2, Andrei Rares1, Hans Reiber1, Yves Louvard3 1Division of image processing, Dept. of Radiology, Leiden University Medical Center, The Netherlands,2Medis medical imaging systems BV, Leiden, The Netherlands,3Institute Cardiovasculaire Paris Sud, Massy, France

  2. Goal • Develop and validate an accurate, reproducible and routinely applicable QCA approach for coronary and peripheral bifurcations based upon our extensive experience in QCA

  3. Intended use • Bifurcation QCA software can be used in core laboratories (multi-center bifurcation studies), and in hospitals, on- and off-line, both for mono- and biplane acquisitions • Quick approach for routine practice and research • For non-bifurcation lesions, acquisitions are standardly taken parallel to vessel of interest, thus minimal foreshortening. For bifurcation lesions, optimal view of the ostium is even more important for proper analysis.

  4. Straight analysis limitations I Standard QCA according to standard operating procedures cannot measure the entire length of the lesion at the ostium of the sidebranch

  5. Straight analysis limitations II Tapering of reference diameter function leads to overestimation of reference diameter and percentage diameter stenosis

  6. Requirement for bifurcation analysis Correct reference diameter functions are needed for the three segments

  7. Proximal section Distal1 section Distal 2 section Three sections model for the bifurcation analysis

  8. Explanation of Bifurcation Analysis

  9. Automatic placement of delimiters

  10. Analysis results for distal1 No overestimation of reference diameter  correct %diameter stenosisImproved estimation of obstruction length

  11. Bifurcation validation study 1 Straight analysis according to SOP vs bifurcation analysis - Lesions outside bifurcation - Lesions partly inside bifurcation

  12. Bifurcation vs. straight analysis Bifurcation and straight analysis results are very similar for lesions outside of bifurcation

  13. Bifurcation vs. straight analysis Straight analysis cannot always detect the actual MLD and lesion length at the bifurcation

  14. Bifurcation validation study 2 Straight analysis over bifurcation vs Bifurcation analysis

  15. Bifurcation vs. straight analysis Straight analysis over the bifurcation cannot detect the correct reference diameter and percentage diameter stenosis

  16. Inter-observer variability of bifurcation analysis

  17. Conclusions • Improvements with respect to straight QCA analysis: • Easier analysis workflow • Reference diameter calculation • %Diameter stenosis calculation • Obstruction length measurement

  18. Conclusions • The new bifurcation QCA software is based on a proper model for the bifurcation anatomy • Bifurcation QCA should be used for bifurcation analyses instead of straight QCA

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