Three‐dimensional on‐line reconstruction of coronary bifurcated lesions to optimize side‐branch stenting

Schlundt, Christian; Kreft, Johann‐Gerhard; Fuchs, Friedrich; Achenbach, Stephan; Daniel, WG; Ludwig, Josef

doi:10.1002/ccd.20653

Cited by 21 publications

(18 citation statements)

References 9 publications

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“…To our knowledge, this is the first study, which shows the value of using biplane angiography for the extraction of the luminal dimensions with 3D reconstruction for measuring coronary lesions. 18,19 Looking in more detail, good agreement was observed between mean QCA and ICUS measurements for the whole artery and for native segments (r = 0.67 and r = 0.73, respectively); the results are in accordance with those previously reported in the literature. [5][6][7][8][9] Further analysis showed that the correlation was stronger when the ICUS frames proximal and distal to side branches origins were excluded (r = 0.75, P < .01 for the whole [1881 ICUS frames] and r = 0.8; P < .01 for the native [1394 ICUS frames] arterial segments).…”

Section: Discussionsupporting

confidence: 93%

Comparison of Quantitative Coronary Angiography with Intracoronary Ultrasound. Can Quantitative Coronary Angiography Accurately Estimate the Severity of a Luminal Stenosis?

Bourantas

Tweddel²,

Papafaklis

et al. 2008

Angiology

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In this study we investigated the accuracy of monoplane and biplane quantitative coronary angiography in estimating the luminal dimensions, using intracoronary ultrasound as gold standard. Biplane angiography and intracoronary ultrasound were performed in 24 arterial segments. The end-diastolic intracoronary ultrasound frames were manually selected and segmented. In 2 end-diastolic X ray projections, quantitative coronary angiography was performed and a novel methodology was applied to register the segmented frames onto the processed angiographic images. The luminal areas determined by quantitative coronary angiography in 1 (monoplane) and 2 projections (mean) were compared with those determined by intracoronary ultrasound. The obtained correlation coefficients for the monoplane and mean estimations were 0.69 +/- 0.12 and 0.77 +/- 0.08, respectively. It would appear that by increasing the angle between the biplane projections, the correlation between intracoronary ultrasound and mean estimations improves. Our results provide evidence that orthogonal biplane angiography is more reliable and should be preferred to assess luminal dimensions.

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Section: Discussionsupporting

confidence: 93%

Comparison of Quantitative Coronary Angiography with Intracoronary Ultrasound. Can Quantitative Coronary Angiography Accurately Estimate the Severity of a Luminal Stenosis?

Bourantas

Tweddel²,

Papafaklis

et al. 2008

Angiology

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“…When treating complex or CTO lesions, radiation management should be incorporated into pre-procedure planning. Also for complex and CTO lesions, the potential for use of advanced technology such as improved interventional devices (34), 3-dimensional vessel modeling (35)(36)(37)(38), or magnetic catheter guidance (39) to reduce dose should be further investigated. This work demonstrates that use of the lateral X-ray plane results in increased patient radiation burden.…”

Section: Discussionmentioning

confidence: 99%

Clinical Determinants of Radiation Dose in Percutaneous Coronary Interventional Procedures

Fetterly

Lennon

Bell

et al. 2011

JACC: Cardiovascular Interventions

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“…Schlundt [15] demonstrated a case in which sidebranch stenting was performed using the on-line 3D reconstruction of the LAD/Diagonal bifurcation to obtain the optimal view with minimal foreshortening and overlap. Sadamatsu [16] reconstructed 18 left main bifurcations in 3D and selected the optimal views based on foreshortening and overlap.…”

Section: Discussionmentioning

confidence: 99%

In vivo assessment of bifurcation optimal viewing angles and bifurcation angles by three-dimensional (3D) quantitative coronary angiography

Jing

Holm

et al. 2011

Int J Cardiovasc Imaging

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Evaluation and stenting of coronary bifurcation lesions may benefit from optimal angiographic views. The anatomy-defined bifurcation optimal viewing angle (ABOVA) is characterized by having an orthogonal view of the bifurcation, such that overlap and foreshortening at the ostium are minimized. However, due to the mechanical constraints of the X-ray systems, certain deep angles cannot be reached by the C-arm. Therefore, second best or, so-called obtainable bifurcation optimal viewing angle (OBOVA) has to be used as an alternative. This study assessed the distributions of ABOVA and OBOVA using 3D quantitative coronary angiography in a typical patient population. In addition, the bifurcation angles in four main coronary bifurcations were assessed and compared. Patients with obstructive coronary bifurcation disease were included in this multicenter registry. A novel and validated 3D QCA software package was applied to reconstruct the bifurcations and to calculate the bifurcation angles in 3D. A list of optimal viewing angle candidates including ABOVA was also automatically proposed by the software. In a next step, the operator selected the best viewing angle as OBOVA, while applying a novel overlap prediction approach to assure no overlap between the target bifurcation and other major coronary arteries. A total of 194 bifurcations from 181 patients were assessed. The ABOVA could not be reached in 56.7% of the cases; being 40 (81.6%), 40 (78.4%), 9 (17.6%), and 21 (48.8%) cases for LM/LAD/LCx, LAD/Diagonal, LCx/OM, and PDA/PLA, respectively. Both ABOVA and OBOVA distributed sparsely with large ranges of variance: LM/LAD/LCx, 5 ± 33 RAO, 47 ± 35 Caudal versus 4 ± 39 LAO, 35 ± 16 Caudal; LAD/Diagonal, 4 ± 38 RAO, 50 ± 14 Cranial versus 14 ± 28 LAO, 33 ± 5 Cranial; LCx/OM, 21 ± 32 LAO, 27 ± 17 Caudal versus 18 ± 31 LAO, 25 ± 13 Caudal; PDA/PLA, 34 ± 21 LAO, 36 ± 21 Cranial versus 28 ± 25 LAO, 29 ± 15 Cranial. LM/LAD/LCx had the smallest proximal bifurcation angle (128° ± 24°) and the largest distal bifurcation angle (80° ± 21°), as compared with LAD/Diagonal (151° ± 13º and 48° ± 16º), LCx/OM (146° ± 18º and 57° ± 16°), and PDA/PLA (145° ± 19° and 59° ± 17°). In conclusion, large variabilities in optimal viewing angles existed for all main coronary bifurcations. The anatomy-defined bifurcation optimal viewing angle could not be reached in vivo in roughly half of the cases due to the mechanical constraints of the current X-ray systems. Obtainable bifurcation optimal viewing angle should be provided as an alternative or second best. The bifurcation angles in the left main bifurcation demonstrated the largest variabilities.

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Three‐dimensional on‐line reconstruction of coronary bifurcated lesions to optimize side‐branch stenting

Cited by 21 publications

References 9 publications

Comparison of Quantitative Coronary Angiography with Intracoronary Ultrasound. Can Quantitative Coronary Angiography Accurately Estimate the Severity of a Luminal Stenosis?

Comparison of Quantitative Coronary Angiography with Intracoronary Ultrasound. Can Quantitative Coronary Angiography Accurately Estimate the Severity of a Luminal Stenosis?

Clinical Determinants of Radiation Dose in Percutaneous Coronary Interventional Procedures

In vivo assessment of bifurcation optimal viewing angles and bifurcation angles by three-dimensional (3D) quantitative coronary angiography

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