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On-Site Computed Tomography Versus Angiography Alone to Guide Coronary Stent Implantation: A Prospective Randomized Study.

Authors :
Opolski MP
Schumacher SP
Verouden NJW
van Diemen PA
Borucki BA
Sprengers R
Everaars H
de Winter RW
van Rossum AC
Nap A
Bom MJ
Knaapen P
Source :
The Journal of invasive cardiology [J Invasive Cardiol] 2020 Nov; Vol. 32 (11), pp. E268-E276. Date of Electronic Publication: 2020 Sep 10.
Publication Year :
2020

Abstract

Objectives: The effect of intraprocedural coronary computed tomography angiography (coronary CTA) guidance on percutaneous coronary intervention (PCI) is unknown. We sought to determine the influence of CTA guidance on procedural strategies and immediate angiographic outcomes of PCI.<br />Methods: Sixty patients were randomized to CTA-guided PCI (29 patients, 36 lesions) or angiography-guided PCI (31 patients, 39 lesions). To enable hands-free manipulation of CTA images by the interventional cardiologist during PCI, we developed an onsite augmented-reality (AR) system comprising a mobile application and AR glass. The primary endpoints were defined as: (1) stent length; and (2) largest stent diameter according to compliance chart. Procedural strategies, two-dimensional (2D) and three-dimensional (3D) quantitative coronary angiography (QCA), and safety outcomes were compared.<br />Results: Whereas CTA guidance resulted in significantly higher frequency of stent postdilation using non-compliant (67% vs 31%; P<.01) and shorter balloons (16.6 ± 5.4 mm vs 20.5 ± 9.4 mm; P=.04) with numerically larger diameter (3.50 ± 0.63 mm vs 3.28 ± 0.45 mm; P=.10), it did not differ from angiography guidance with respect to lesion predilation, stent length, largest stent diameter according to compliance chart, and nominal stent diameter. The results of 2D- and 3D-QCA and safety outcomes were similar between groups. Neither death nor stroke occurred in either group.<br />Conclusions: PCI under intraprocedural CTA guidance is associated with similar stent size selection and more frequent stent postdilation, resulting in comparable immediate angiographic and safety outcomes as compared with PCI under angiographic guidance alone.

Details

Language :
English
ISSN :
1557-2501
Volume :
32
Issue :
11
Database :
MEDLINE
Journal :
The Journal of invasive cardiology
Publication Type :
Academic Journal
Accession number :
32911462