Determination of Optimal Fluoroscopic Angulations for Left Main Coronary Artery Ostial Interventions: 3-Dimensional Computed Tomography Validation. (10th March 2022)

• Record Type: Journal Article
• Authors: Sheng, Yuhe; Yu, Jie; Jing, Quanmin; Han, Yaling; Li, Yi; Xu, Kai; Qiu, Miaohan; Wang, Yingdong; Mintz, Gary S.; Wang, Bin
• Other Names: Maekawa Yuichiro Academic Editor.
• Is Part Of: Journal of interventional cardiology. Volume 2022(2022)
• Publication Date: 2022-03-10
• Subjects: Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.1206
• DOI: 10.1155/2022/2411824
• Languages: English
• ISSNs: 0896-4327

Abstract

Abstract : Background . Current recommendations for the best views for the left main coronary artery (LMCA) ostium intervention are empirical. Objectives . To determine the optimal projection to visualize the LMCA ostium using only fluoroscopy. Methods . The optimal projection to visualize the LMCA ostium was determined using fluoroscopic images of superimposing the lowest points of the distal ends of two J tipped wires in the noncoronary cusp (NCC) and right coronary cusp (RCC). This was validated independently using 3-dimensional computed tomography (3D-CT) reconstruction. Results . Satisfactory images of the overlapping wires in NCC and RCC could be obtained in 90% (45/50). Between the fluoroscopic and the 3D-CT reconstruction approaches, the mean difference for NCC and RCC overlapping at horizontal axes is -1.8 with a 95% limit of agreement between −3.94 and 0.34 p = 0.10 and at vertical axes −1.6 with a 95% limit of agreement between −3.46 and 0.26 p = 0.09 ; and the mean difference for the optimal projection to visualize the LMCA ostium at horizontal axes is −3.22 with a 95% limit of agreement between -7.26 and 0.81 p = 0.11 and at vertical axes −2.31 with a 95% limit of agreement between −5.83 and 1.21 p = 0.09 . The 3D angulation deviation for the optimal projection to visualize the LMCA ostium was 8.5° ± 4.7° when the LMCA ostium faced the NCC-RCC commissure ( n = 32) and 22.3° ± 16.0° p = 0.009 when it did not ( n = 13). Conclusions . The optimal projection for LMCA ostial intervention can be determined using fluoroscopic images of superimposing wires in the NCC and RCC when the LMCA ostium faces the NCC-RCC commissure, as was the case in 71% of the patients studied.