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Angio/MSCT co-registration for bifurcation lesions

Angio/MSCT co-registration for bifurcation lesions. Robert J. M. van Geuns Carl Schultz Steve Ramcharitar Michael Magro Cihan Simsek Patrick W. Serruys Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands. Plaque distribution is important for success (IVUS)

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Angio/MSCT co-registration for bifurcation lesions

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  1. Angio/MSCT co-registration for bifurcation lesions Robert J. M. van Geuns Carl Schultz Steve Ramcharitar Michael Magro Cihan Simsek Patrick W. Serruys Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.

  2. Plaque distribution is important for success (IVUS) MSCT is able to visualize plaque distribution non-invasively Bifurcation angle is important for technique applied 3D measurements are most accurate. MSCT in bifurcations Rodriguez-Granillo GAMultislice CT coronary angiography for the detection of burden, morphology and distribution of atherosclerotic plaques in the left main bifurcation. Int J Cardiovasc Imaging. 2007 Jun;23(3):389-92 Ormiston JA, Drug-eluting stens for coronary bifurcations: Insights into the crush technique. CCI 2004 Kawasaki T, The bifurcation study using 64 slice CT. CCI:2009

  3. MSCT of bifurcation lesions PL Large plaque around bifurcation PDA MIP

  4. MSCT frequently used for diagnosis Extend of atherosclerotic disease Virtual IVUS Co-registration with MSCT • Better identification calcification • Avoid redo-lumenography • MSCT centerlines for navigation

  5. MSCT overlays • Simple lesions (reduced to zero contrast) • Chronic total occlusions (475 +- 192 ml) • Bifurcations (Nordic: 250 ml)

  6. Co-registration with MSCT:Non-contrast PCI Ramcharitar, Geuns, J Am Coll Cardiol. 2009 Mar 3;53(9):741-6

  7. Co-registration with MSCT:Non-contrast PCI Ramcharitar, Geuns, J Am Coll Cardiol. 2009 Mar 3;53(9):741-6

  8. Co-registration with MSCT:Non-contrast PCI Ramcharitar, Geuns, J Am Coll Cardiol. 2009 Mar 3;53(9):741-6

  9. Coronary angiography

  10. MSCT PL Large plaque around bifurcation PDA MIP

  11. Magnetic Navigation Stereotaxis

  12. Nile Croco implantation

  13. Nile Croco implantation Kissing Post Kissing Prox: 113° Dist: 79 °

  14. Example of MSCT overlay for complex procedure

  15. Limitations of MSCT • Additional radiation • Static overlay • Limited resolution • 3D angiography • Two imaging planes • Rotational angiography • 2 – 3 angiography images • At least 30º apart • Same phase of the heart cycle (Optimal – End Diastole) >30º

  16. 3D angiography Paieon Inc

  17. Case Patient: L, male, 58 y.o. Risk factors Stopped smoking for 1 year Past/Clinical history: 10 March 2008 Non-STEMI, Late presenter Post infarct angina COPD

  18. 3D angiography

  19. Guidance of Distal Stent

  20. Guidance of Main-Branch Stent

  21. How about 3D-angio ?

  22. Or 4D-angio??

  23. MSCT useful for pre-intervention analysis of bifurcation (LM!) MSCT overlays can reduce contrast usages during PCI 3D angiography online alternative Less plaque visualization Possible motion compensation Summary

  24. Crossing Times in 31 Bifurcation lesions Success 96.8% 90.0% Magnet Convent Time/sec Ramcharitar, Geuns, EHJ in press

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