MSCT integration for complex bifurcation Alice Ohanessian MC Morice, T. Lefevre, Y.Louvard ICPS, Massy France Institut Cardiovasculaire Paris Sud.

MSCT integration for complex bifurcation

Alice OhanessianMC Morice, T. Lefevre, Y.Louvard

ICPS, Massy France

Institut Cardiovasculaire Paris Sud

CT integration for bifurcationbackground

• Tremendous improvement of Cardiac CT

• 64 slices CT

• Incredible perspectives

• New tool for facilitated coronary angioplasty ?

Institut Cardiovasculaire Paris Sud

CT integration for bifurcationhow ?

• New concept developped by manufacturers

• One or two screens dedicated to CT integrated in the cath lab

• Screens directely connected to a CT work station outside the cath lab

Institut Cardiovasculaire Paris Sud

CT integration for bifurcationhow does it work ?

• Cardiac CT is first performed in scan unit

• Images are post treated like usually

• Selected phases and images are then transfered to the CT work station in the cath lab unit

Institut Cardiovasculaire Paris Sud

1. From the CT work station

2. From the cath lab

Institut Cardiovasculaire Paris Sud

CT integration for bifurcationwhat can we do ?

CT integration for bifurcation 1. from the CT work station

Institut Cardiovasculaire Paris Sud

CT integration for bifurcation 1. from the CT work station

• Coronary tree reconstruction

• select cardiac CT images

• define optimal view to display the lesion and plaque extension

• select the best angle to work during PCI

Institut Cardiovasculaire Paris Sud

CT integration for bifurcation 1. from the CT work station

• Mesure the true lesion length

• Appreciate the true shortening

• Plaque extension

• Anatomic relation with side branch

• Ostial lesion of side branch (bifurcation)

Institut Cardiovasculaire Paris Sud

CT integration for bifurcation 2- from the cath lab

Institut Cardiovasculaire Paris Sud

CT integration for bifurcation 2- from the cath lab

• Appreciate at the same time angiographic view and anatomic view

• Grant tube and CT images (3D, angio) synchronized

• Call the view previously selected • No wasted contrast media in choosing

the optimal view (tube rotation makes rotate CT view)

Institut Cardiovasculaire Paris Sud

CT integration for bifurcationImprovement for opertor

• Save procedural time

• Select best view without contrast or scopie

• Less irradiation

• Optimize PCI strategy

• Increase procedural success in complex PCI and complex anatomy

Institut Cardiovasculaire Paris Sud

CT integration for bifurcationimprovement for the patient

• Procedure is shorter

• Improve patient comfort

• Less contrast medium used

• Less renal failure

• Less irradiation: but MSCT irradiation

Institut Cardiovasculaire Paris Sud

CT integration for bifurcationcomplex bifurcation: angio

Institut Cardiovasculaire Paris Sud

CT integration for bifurcationcomplex bifurcation: MSCT

Institut Cardiovasculaire Paris Sud

CT integration for bifurcationcomplex bifurcation: integration

Institut Cardiovasculaire Paris Sud

CT integration for bifurcationPCI procedure

Institut Cardiovasculaire Paris Sud

CT integration for bifurcation tube and 3D view synchronization

Institut Cardiovasculaire Paris Sud

CT integration for bifurcationtrifurcation result

Institut Cardiovasculaire Paris Sud

CT integration for bifurcationconclusion

• MSCT integration in the cath lab is a new tool

for interventional cardiologist

• Important improvement in the approach of

complex PCI

• Shorter procedure, less contrast media

• Reserved to complex cases

• Dose modulation +++(3-5msv)

Institut Cardiovasculaire Paris Sud