Three-dimensional coronary imaging for the ostium of the left anterior descending artery
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Conventional coronary angiography is subject to a significant foreshortening of the proximal left anterior descending artery and overlapping of the left anterior descending artery and the circumflex artery that limits the accurate identification of the ostium of the left anterior descending artery. The aim of this study was to determine whether the three-dimensional (3D) reconstruction of traditional coronary angiography could optimize the projection angle to clearly show the ostium of the left anterior descending artery. The left main bifurcations of 18 consecutive patients were analyzed. A 3D image of the bifurcation was reconstructed from two conventional images and the optimal projection angle was chosen to clearly identify the ostium of the left anterior descending artery. The optimal angle was the right anterior oblique 18.8 ± 20.9°-caudal 26.9 ± 32.3°. The length from the left main trunk to the proximal left anterior descending artery on the optimal views was significantly longer than that on the routine views (25.0 ± 6.1 vs. 22.4 ± 5.3 mm, P = 0.011). The angles of the left main bifurcations were not substantially different between the optimal and the routine views. The optimal views selected using the 3D system provided clearer images of the ostium of the left anterior descending artery with less overlapping and foreshortening.
KeywordsCoronary angiography Coronary stenosis Three-dimensional imaging Intravascular ultrasound
Left anterior descending artery
Left circumflex artery
Interventional cardiac three-dimensional
Right anterior oblique
Left anterior oblique
The movie demonstrates the optimization steps.
A 3D vessel model was reconstructed automatically from 2 conventional angiographic images using the interventional cardiac 3D system. The projection angle of the image of the reconstructed 3D vessel model is shown in the upper right portion of the movie. First of all, we rotated the model to elongate the ostial LAD and to maximize the bifurcation angle. RAO 58-caudal 46 was indicated in the upper right portion of the movie, however, the font color showing the angle turned red, as a result, this angle was not considered to be practical. We therefore rotated the vessel model to the possible angle range, while carefully avoiding any overlapping of the bifurcation and foreshortening of the LAD, as a result, an angle of RAO58-caudal 42 was thus obtained.
3D, three-dimensional; LAD, left anterior descending artery; RAO, right anterior oblique. (MOV 498 kb)
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