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Beneki E, Dimitriadis K, Pyrpyris N, Antonopoulos A, Aznaouridis K, Antiochos P, Fragoulis C, Lu H, Meier D, Tsioufis K, Fournier S, Aggeli C, Tzimas G. Computed Tomography Angiography in the Catheterization Laboratory: A Guide Towards Optimizing Coronary Interventions. J Cardiovasc Dev Dis 2025; 12:28. [PMID: 39852306 PMCID: PMC11766008 DOI: 10.3390/jcdd12010028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2024] [Revised: 01/04/2025] [Accepted: 01/10/2025] [Indexed: 01/26/2025] Open
Abstract
Cardiac computed tomography (CT) has become an essential tool in the pre-procedural planning and optimization of coronary interventions. Its non-invasive nature allows for the detailed visualization of coronary anatomy, including plaque burden, vessel morphology, and the presence of stenosis, aiding in precise decision making for revascularization strategies. Clinicians can assess not only the extent of coronary artery disease but also the functional significance of lesions using techniques like fractional flow reserve (FFR-CT). By providing comprehensive insights into coronary structure and hemodynamics, cardiac CT helps guide personalized treatment plans, ensuring the more accurate selection of patients for percutaneous coronary interventions or coronary artery bypass grafting and potentially improving patient outcomes.
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Affiliation(s)
- Eirini Beneki
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece; (E.B.); (N.P.); (A.A.); (K.A.); (C.F.); (K.T.); (C.A.)
| | - Kyriakos Dimitriadis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece; (E.B.); (N.P.); (A.A.); (K.A.); (C.F.); (K.T.); (C.A.)
| | - Nikolaos Pyrpyris
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece; (E.B.); (N.P.); (A.A.); (K.A.); (C.F.); (K.T.); (C.A.)
| | - Alexios Antonopoulos
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece; (E.B.); (N.P.); (A.A.); (K.A.); (C.F.); (K.T.); (C.A.)
| | - Konstantinos Aznaouridis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece; (E.B.); (N.P.); (A.A.); (K.A.); (C.F.); (K.T.); (C.A.)
| | - Panagiotis Antiochos
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland; (P.A.); (H.L.); (D.M.); (S.F.); (G.T.)
| | - Christos Fragoulis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece; (E.B.); (N.P.); (A.A.); (K.A.); (C.F.); (K.T.); (C.A.)
| | - Henri Lu
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland; (P.A.); (H.L.); (D.M.); (S.F.); (G.T.)
| | - David Meier
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland; (P.A.); (H.L.); (D.M.); (S.F.); (G.T.)
| | - Konstantinos Tsioufis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece; (E.B.); (N.P.); (A.A.); (K.A.); (C.F.); (K.T.); (C.A.)
| | - Stephane Fournier
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland; (P.A.); (H.L.); (D.M.); (S.F.); (G.T.)
| | - Constantina Aggeli
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece; (E.B.); (N.P.); (A.A.); (K.A.); (C.F.); (K.T.); (C.A.)
| | - Georgios Tzimas
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland; (P.A.); (H.L.); (D.M.); (S.F.); (G.T.)
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Incidence and prognostic impact of the calcified nodule in coronary artery disease patients with end-stage renal disease on dialysis. Heart Vessels 2022; 37:1662-1668. [PMID: 35499643 DOI: 10.1007/s00380-022-02076-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 04/08/2022] [Indexed: 01/15/2023]
Abstract
Coronary artery calcification is frequently observed in coronary artery disease (CAD) patients with end-stage renal disease (ESRD). Calcified nodule (CN) is recognized as one of the vulnerable plaque characteristics responsible for acute coronary syndrome (ACS). Although CN is a cause of ACS in only 10%, its prevalence may be higher in elderly patients and/or ESRD. The aim of this study is to investigate incidence, clinical characteristics, and prognostic impact of CN in CAD patients with ESRD on dialysis. A total of 51 vessels from 49 CAD patients with ESRD on dialysis were enrolled in this study. CN was defined as a high-backscattering mass protruding into the lumen with a strong signal attenuation and an irregular surface by optical coherence tomography. Incidence, clinical characteristics and prognosis of patients with CN were studied. Major adverse cardiac events (MACE) were defined as a composite of all-cause death, non-fatal myocardial infarction, target vessel revascularization (TVR) and stroke. CNs were observed in 30 vessels from 29 patients (59.2%). Duration of dialysis was significantly longer in CN group than in non-CN group (P = 0.03). Overall, all-cause death, cardiac death, TVR and MACE occurred in 7 (14.3%), 3 (6.1%), 11 (22.4%) and 16 (32.7%) patients during follow-up (median 826 days), respectively. Kaplan-Meier survival analysis revealed that MACE-free survival was significantly lower in patients with CN compared with those without CN (Log-rank, P = 0.036).In conclusion, CN was observed in about 60% of the CAD patients with ESRD and was associated with duration of dialysis and worse prognosis.
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Sadamatsu K, Okutsu M, Sumitsuji S, Kawasaki T, Nakamura S, Fukumoto Y, Tsujita K, Sonoda S, Kobayashi Y, Ikari Y. Practical utilization of cardiac computed tomography for the success in complex coronary intervention. Cardiovasc Interv Ther 2021; 36:178-189. [PMID: 33428155 DOI: 10.1007/s12928-020-00751-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 12/22/2020] [Indexed: 12/12/2022]
Abstract
Percutaneous coronary intervention (PCI) for complex lesions is still technically demanding and is associated with less favorable procedural parameters such as lower success rate, longer procedural time, higher contrast volume and unexpected complications. Because the conventional angiographic analysis is limited by the inability to visualize the plaque information and the occluded segment, cardiac computed tomography has evolved as an adjunct to invasive angiography to better characterize coronary lesions to improve success rates of PCI. Adding to routine image reconstructions by coronary computed tomography angiography, the thin-slab maximum intensity projection method, which is a handy reconstruction technique on an ordinary workstation, could provide easy-to-understand images to reveal the anatomical characteristics and the lumen and plaque information simultaneously, and then assist to build an in-depth strategy for PCI. Especially in the treatment of chronic total occlusion lesion, these informations have big advantages in the visualization of the morphologies of entry and exit, the occluded segment and the distribution of calcium compared to invasive coronary angiography. Despite of the additional radiation exposure, contrast use and cost for cardiac computed tomography, the precise analysis of lesion characteristics would consequently improve the procedural success and prevent the complication in complex PCI.
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Affiliation(s)
- Kenji Sadamatsu
- Department of Cardiovascular Medicine, Omuta City Hospital, 2-19-1 Takarazaka-machi, Omuta, Fukuoka, 836-8567, Japan.
| | - Masaaki Okutsu
- Department of Cardiovascular Medicine, New Tokyo Hospital, Matsudo, Japan
| | - Satoru Sumitsuji
- Department of Cardiology for International Education and Research, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tomohiro Kawasaki
- Cardiovascular and Heart Rhythm Center, Shin-Koga Hospital, Kurume, Japan
| | - Sunao Nakamura
- Department of Cardiovascular Medicine, New Tokyo Hospital, Matsudo, Japan
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Kumamoto University Graduate School of Medical Science, Kumamoto, Japan
| | - Shinjo Sonoda
- Second Department of Internal Medicine, School of Medicine, University of Occupational and Environ- Mental Health, Kitakyushu, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yuji Ikari
- Department of Cardiology, Tokai University, Kanagawa, Japan
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Percutaneous Coronary Intervention for Coronary Bifurcation Lesions: Latest Evidence. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020; 22:6. [PMID: 32034505 DOI: 10.1007/s11936-020-0806-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW This paper provides a synopsis of the best evidence to guide bifurcation percutaneous coronary intervention (PCI), with a focus on recent studies. This is with the aim of guiding the interventional cardiologist in choosing the best, evidence-based technique, to treat commonly encountered coronary bifurcations. RECENT FINDINGS Current evidence supports the use of provisional stenting for most anatomically suitable bifurcation lesions. Newer techniques for side branch protection in provisional stenting have been developed. When a two-stent strategy is required, use of a double-kissing crush technique is favoured, particularly in left main bifurcations. For bifurcation PCI, as in all complex procedures, intravascular imaging plays a key adjunctive role in improving procedural success. PCI for coronary bifurcation lesions is an ever-growing field with significant advancements in techniques and technology.
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