Real-time fusion of coronary CT angiography with x-ray fluoroscopy during chronic total occlusion PCI

Ghoshhajra, Brian B.; Takx, Richard A.P.; Stone, Luke L.; Girard, Erin; Brilakis, Emmanouil S.; Lombardi, William; Yeh, Robert W.; Jaffer, Farouc A.

doi:10.1007/s00330-016-4599-5

Cited by 45 publications

(20 citation statements)

References 22 publications

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“…Recently, a more challenging approach involving realtime fusion of three-dimensional coronary CTA with X-ray fluoroscopy for guiding CTO PCI has been investigated. In a study by Ghoshhajra et al among 24 consecutive CTO PCI patients, CTA/fluoroscopy fusion provided new insights into the extent and localisation of coronary calcification as well as vessel tortuosity, potentially influencing antegrade wiring, antegrade and dissection re-entry, and retrograde wiring strategies [35]. Similar findings were reported by Xenogiannis et al, in whose study CTA/fluoroscopy fusion was used in 27 of 146 CTO PCI cases performed between 2018 and 2019 within the PROGRESS-CTO registry [36].…”

Section: Coronary Cta/fluoroscopy Fusion Guidancementioning

confidence: 99%

“…The CTAbased hybrid algorithm for the presented case (g). AFR antegrade fenestration and re-entry, CRAN cranial, CSA crosssectional area, LAST limited antegrade subintimal tracking, RAO right anterior oblique, STAR subintimal tracking and reentry the first to examine the influence of coronary CTA for guiding CTO PCI using the hybrid algorithm [35,36].…”

Section: Coronary Cta/fluoroscopy Fusion Guidancementioning

confidence: 99%

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A computed tomography algorithm for crossing coronary chronic total occlusions: riding on the wave of the proximal cap and distal vessel segment

2020

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With wider adoption of coronary computed tomography angiography (coronary CTA), chronic total occlusions (CTOs) are being increasingly identified and characterised by non-invasive angiography. In particular, the ability of coronary CTA to clearly delineate atherosclerotic plaque, as well as to display three-dimensional vessel trajectories, has garnered particular attention in the context of preprocedural planning and periprocedural guidance of CTO percutaneous coronary intervention (PCI). Single CTO features and combined scoring systems derived from CTA (mostly exceeding the diagnostic performance of the angiographic J‑CTO score) have been used to predict time-efficient guidewire crossing, and thus grade the CTO difficulty level prior to PCI. In addition, the introduction of three-dimensional CTA/fluoroscopy co-registration for periprocedural navigation during CTO PCI offers the unprecedented opportunity to resolve proximal cap ambiguity and clearly visualise the distal CTO segment, thereby potentially influencing CTO PCI strategies and techniques. In this review, the potential advantages of non-invasive evaluation of CTO by coronary CTA are described, and a CTA-based hybrid algorithm is introduced for further enhancing the efficiency of CTO PCI. Further studies are clearly needed to verify the proposed approach. However, several luminary operators have already implemented coronary CTA for planning and periprocedural guidance of CTO interventions using the hybrid algorithm.

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Section: Coronary Cta/fluoroscopy Fusion Guidancementioning

confidence: 99%

Section: Coronary Cta/fluoroscopy Fusion Guidancementioning

confidence: 99%

A computed tomography algorithm for crossing coronary chronic total occlusions: riding on the wave of the proximal cap and distal vessel segment

2020

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“…99 CT guidance by real-time automated co-registration of coronary CTA centreline and calcification onto live fluoroscopic images has been shown to be feasible. 100 concluSion In summary, CT is an increasingly important imaging tool for the expanding field of structural cardiac disease interventions. Current indications for pre-procedural CT imaging in cardiac interventional procedures include transcatheter aortic valve implantation, percutaneous interventions of the mitral, tricuspid and pulmonary valves, LAA occlusion, paravalvular leak occlusion as well as percutaneous revascularization of coronary chronic total occlusions.…”

Section: Percutaneous Revascularization Of Coronary Chronic Total Occmentioning

confidence: 99%

CT support of cardiac structural interventions

Hell

Achenbach

2019

BJR

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The most frequent indication of cardiac CT imaging is to detect and rule out coronary artery stenosis. 1-3 Intravenous contrast is injected for the purpose of coronary lumen visualization and the procedure is referred to as "coronary CT angiography" (CTA). In a broader sense, "cardiac CTA" refers to contrast-enhanced visualization of the morphology and structure of the entire heart and adjacent great vessels. In fact, due to its high spatial resolution which is well below 1 mm in all orientations, contrast-enhanced cardiac CT imaging has emerged as a valuable tool for morphological cardiac imaging in the past years. 4 With their close to isotropic spatial resolution, modern CT scanners allow the reconstruction of data sets in any desired plane without losing the ability to visualize small structures and perform exact measurements.

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“…To implement perfect integration with the real–world environment for medical educational training 4 , 5 , stroke rehabilitation 32 , psychotherapy 6 , 33 and so on, VR has been alternated with AR and MR which merge the real and virtual environments. Moreover, it is clear that AR and computer-mediated reality are very helpful for navigation in medical applications (e.g., orthopedic surgery 7 – 9 , interventional procedures 9 , 34 – 36 ). Complex interventional procedures with a high requirement for spatial information may be difficult and time consuming to perform under fluoroscopic guidance without 3D depth perception.…”

Section: Discussionmentioning

confidence: 99%

Realization of real-time X-ray stereoscopic vision during interventional procedures

Deng

Wei

Chen

et al. 2018

Sci Rep

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During interventional procedures, the deficiencies of nonstereoscopic vision increase the difficulty of identifying the anteroposterior direction and pathways of vessels. Therefore, achieving real-time stereoscopic vision during interventional procedures is meaningful. Pairs of X-ray images were captured with identical parameter settings, except for different rotation angles (represented as the α angle). The resulting images at these α angles were used as left-eye and right-eye views and were horizontally merged into single left-right 3D images. Virtual reality (VR) glasses were used for achieving stereo vision. Pairs of X-ray images from four angiographies with different α angles (1.8–3.4°) were merged into left-right 3D images. Observation with VR glasses can produce realistic stereo views of vascular anatomical structure. The results showed that the optimal α angles accepted by the brain for generating stereo vision were within a narrow range (approximately 1.4–4.1°). Subsequent tests showed that during transcatheter arterial chemoembolization, 3D X-ray stereoscopic images provided significantly improved spatial discrimination and convenience for identifying the supply vessels of a liver tumor and its anteroposterior direction compared with plain X-ray images (all P < 0.01). Real-time X-ray stereoscopic vision can be easily achieved via the straightforward method described herein and has the potential to benefit patients during interventional procedures.

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Real-time fusion of coronary CT angiography with x-ray fluoroscopy during chronic total occlusion PCI

Abstract: • Real-time semi-automated fusion of CTA/fluoroscopy is feasible during CTO PCI. • CTA fusion data can be toggled on/off as desired during CTO PCI • Real-time CT calcium and centreline overlay could benefit antegrade dissection/reentry-based CTO PCI.

Cited by 45 publications

References 22 publications

A computed tomography algorithm for crossing coronary chronic total occlusions: riding on the wave of the proximal cap and distal vessel segment

A computed tomography algorithm for crossing coronary chronic total occlusions: riding on the wave of the proximal cap and distal vessel segment

CT support of cardiac structural interventions

Realization of real-time X-ray stereoscopic vision during interventional procedures

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