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Case
A 59-year old male, with a history of inferoposterior myocardial infarction and multiple coronary stenting, presented to the out-patient clinic with exercise-related chest discomfort. The electrocardiogram showed sinus rhythm with Q-waves in the inferior leads (Figure 1) . Coronary computed tomography angiography (CTA) showed stents in the right coronary artery (RCA), left anterior descending artery (LAD), and intermediate branch (IM), however, obstructive coronary artery disease (CAD) could not be reliably assessed (Figure 2). Sequentially, adenosine stress CT myocardial perfusion (CTP) was performed and indicated anterolateral ischemia and the old inferoposterior scar (Figure 3). Using 3-Dimensional (3D) fusion of the coronary anatomy and stress perfusion images, the new myocardial ischemia could be allocated to the territory of the first diagonal branch (D1) (Figure 4). Invasive coronary angiography demonstrated patency of the previous stents and a significant lesion of the proximal D1, which was successfully stented (Figure 5).
Discussion
To perform CT coronary anatomy and myocardial perfusion imaging in the same setting is an efficient way to diagnose an old myocardial infarction, new myocardial ischemia, and to allocate the ischemia to its corresponding coronary artery by 3D fusion and thereby guiding the revascularization procedure; the so-called one-stop-shop!
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Alexander R. van Rosendael is supported by a research grant from the Interuniversity Cardiology Institute of the Netherlands (ICIN, Utrecht, The Netherlands). The Department of Cardiology received research grants from Biotronik, Medtronic, Boston Scientific Corporation and Edwards Lifesciences.
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van Rosendael, A.R., Dimitriu-Leen, A.C., Montero-Cabezas, J.M. et al. One-stop-shop cardiac CT: 3D fusion of CT coronary anatomy and myocardial perfusion for guiding revascularization in complex multivessel disease. J. Nucl. Cardiol. 23, 1510–1513 (2016). https://doi.org/10.1007/s12350-015-0324-z
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DOI: https://doi.org/10.1007/s12350-015-0324-z