Real-time fusion of coronary CT angiography with x-ray fluoroscopy during chronic total occlusion PCI.
OBJECTIVE
The purpose of this study was to demonstrate the feasibility of real-time fusion of coronary computed tomography angiography (CTA) centreline and arterial wall calcification with x-ray fluoroscopy during chronic total occlusion (CTO) percutaneous coronary intervention (PCI).


METHODS
Patients undergoing CTO PCI were prospectively enrolled. Pre-procedural CT scans were integrated with conventional coronary fluoroscopy using prototype software. We enrolled 24 patients who underwent CTO PCI using the prototype CT fusion software, and 24 consecutive CTO PCI patients without CT guidance served as a control group.


RESULTS
Mean age was 66 ± 11 years, and 43/48 patients were men. Real-time CTA fusion during CTO PCI provided additional information regarding coronary arterial calcification and tortuosity that generated new insights into antegrade wiring, antegrade dissection/reentry, and retrograde wiring during CTO PCI. Overall CTO success rates and procedural outcomes remained similar between the two groups, despite a trend toward higher complexity in the fusion CTA group.


CONCLUSIONS
This study demonstrates that real-time automated co-registration of coronary CTA centreline and calcification onto live fluoroscopic images is feasible and provides new insights into CTO PCI, and in particular, antegrade dissection reentry-based CTO PCI.


CONCLUSIONS
• 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.
Cardiac MR PET CT Program, Massachusetts General Hospital, Department of Radiology and Division of Cardiology, Harvard Medical School, Boston, MA, USA.
Brian B
BB
Ghoshhajra
Cardiac MR PET CT Program, Massachusetts General Hospital, Department of Radiology and Division of Cardiology, Harvard Medical School, Boston, MA, USA.
Richard A P
RAP
Takx
Cardiac Cathetrization Laboratory, Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
Luke L
LL
Stone
Siemens Healthcare, Princeton, NJ, USA.
Erin E
EE
Girard
Cardiology Division, Dallas VA Medical Center and UT Southwestern Medical Center, Dallas, TX, USA.
Emmanouil S
ES
Brilakis
Cardiology Division, University of Washington, Seattle, WA, USA.
William L
WL
Lombardi
Cardiac Cathetrization Laboratory, Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
Robert W
RW
Yeh
Cardiac Cathetrization Laboratory, Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States. fjaffer@mgh.harvard.edu.
Farouc A
FA
Jaffer
D000368:Aged; D016022:Case-Control Studies; D002908:Chronic Disease; D000072226:Computed Tomography Angiography / Q000379:methods*; D017023:Coronary Angiography / Q000379:methods; D054059:Coronary Occlusion / Q000000981:diagnostic imaging* / Q000601:surgery; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D010865:Pilot Projects; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000601:surgery
Atherosclerosis; Automatic data processing; Coronary angiography; Multidetector computed tomography; Percutaneous coronary intervention
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