Post-Procedure Micro-CT Analyses of Coronary Artery Stenting in Left Main Vessels of Human Hearts

Abstract

Background: Percutaneous coronary interventions (PCIs) within left main coronary arteries are high-risk procedures that require optimization of interactions between stent(s) and diseased vessels. Optical Coherence Tomography (OCT) is a widely accepted tool that enhances physicians’ ability to assess proper stent appositions during procedures. The primary aim of this study was to develop complementary post-procedure imaging methodologies to better assess and interpret outcomes of left main PCI procedures, utilizing reanimated and perfusion-fixed human hearts.Methods: PCIs were performed while obtaining OCT scans within the left main anatomies of six human hearts. Following PCI, each heart was scanned with a micro-CT scanner with optimized parameters to achieve resolutions up to 20µm. Scans were reconstructed and imported into DICOM software to segment and generate models of implanted stents and coronary vessels. 2D images that were obtained during PCI from OCT were used to assess the accuracy of 3D models generated from micro-CT reconstructions. Additionally, the 3D models were utilized to create virtual reality scenes and enlarged 3D prints for “mixed reality” physician training and education relative to bifurcation stenting in human left main coronary arteries.Results: We developed a reproducible methodology for post-implant analyses of coronary artery stenting procedures, and created 3D models down to 20 microns of resolution for reanimated and perfusion-fixed heart specimens. Conclusions: These models can be used to obtain detailed measurements for further clinical insight on procedural outcomes. 3D models resulting from these scans are useful for generating virtual reality scenes and 3D prints for physician training and education.

Multimodal Imaging of a Culotte Bifurcation Procedure in the Left Main Coronary Artery of a Perfusion-Fixed Human Heart: Step-by-Step with Serial Micro-CT Analyses

“…Note that the acrylic casing kept the heart in the same position during transportation to/from the micro-CT scanner, which minimized potential damage to the implanted stent(s) Upon completion of the PCI procedure and all OCT and micro-CT imaging, we removed the heart from the acrylic case and placed it back in its formalin storage container. Image processing and data analyses were performed following established operating procedures from our laboratory [13]. In short, OCT image datasets were post-processed using the OPTIS Intravascular Imaging System (Abbott Laboratories) to obtain 2D images capturing the reconstructed stent and its resulting appositions using the Apposition Indicator function.…”