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Practical utilization of cardiac computed tomography for the success in complex coronary intervention

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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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Acknowledgements

We would like to thank our colleagues at Cardiac CT for interventionists conference.

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No funding was received for this work.

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Author notes

  1. Kenji Sadamatsu and Masaaki Okutsu contributed equally to this work.

Authors and Affiliations

  1. Department of Cardiovascular Medicine, Omuta City Hospital, 2-19-1 Takarazaka-machi, Omuta, Fukuoka, 836-8567, Japan

    Kenji Sadamatsu

  2. Department of Cardiovascular Medicine, New Tokyo Hospital, Matsudo, Japan

    Masaaki Okutsu & Sunao Nakamura

  3. Department of Cardiology for International Education and Research, Osaka University Graduate School of Medicine, Osaka, Japan

    Satoru Sumitsuji

  4. Cardiovascular and Heart Rhythm Center, Shin-Koga Hospital, Kurume, Japan

    Tomohiro Kawasaki

  5. Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan

    Yoshihiro Fukumoto

  6. Department of Cardiovascular Medicine, Kumamoto University Graduate School of Medical Science, Kumamoto, Japan

    Kenichi Tsujita

  7. Second Department of Internal Medicine, School of Medicine, University of Occupational and Environ- Mental Health, Kitakyushu, Japan

    Shinjo Sonoda

  8. Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan

    Yoshio Kobayashi

  9. Department of Cardiology, Tokai University, Kanagawa, Japan

    Yuji Ikari

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Correspondence to Kenji Sadamatsu.

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Satoru Sumitsuji reports remuneration for lectures from Canon Medical, and Fujifilm Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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Sadamatsu, K., Okutsu, M., Sumitsuji, S. et al. Practical utilization of cardiac computed tomography for the success in complex coronary intervention. Cardiovasc Interv and Ther 36, 178–189 (2021). https://doi.org/10.1007/s12928-020-00751-6

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