Dr. Carlos Collet discusses how CT imaging can optimize PCI procedures, aid in patient selection, determine coronary artery disease extent, and guide procedural decisions. The importance of myocardial mass evaluation in bifurcation lesions and ongoing trials exploring CT-guided PCI. Limitations of CT imaging and the need for intervascular techniques like OCT for assessing procedure results.
CT imaging in PCI procedures provides valuable information for planning, selecting appropriate catheters, and avoiding complications like coronary dissection.
CT plays a crucial role in the planning stage of PCI procedures by assessing lesion severity, determining if a lesion would benefit from PCI, and guiding stent length selection.
Deep dives
The Evolving Field of Cardiac CT
The field of coronary CT has significantly advanced in recent years, with improved scanners and growing evidence supporting its use for patients with chest pain. CT has become routine in the tablet, providing valuable information for planning percutaneous coronary intervention (PCI) procedures and overcoming limitations of conventional angiography. Cardiac CT helps assess the degree of stenosis and flow limitation, identify different patterns of coronary disease (focal vs. diffuse), and evaluate the extent of calcification. The imaging also aids in selecting appropriate catheters and guiding lesion preparation. CT enables interventional cardiologists to choose the optimal stent length and avoid complications like coronary dissection. Additionally, CT provides insights into the myocardial mass at risk, helping decide whether to include small side branches in the PCI procedure.
The Role of CT in Guiding PCI
CT plays a crucial role in the planning stage of PCI procedures by providing comprehensive information for decision-making. It helps assess the severity of stenosis, identifies the physiological impact of lesions using fractional flow reserve derived from CT (FFRCT), and determines if a lesion would benefit from PCI. By visualizing calcium burden, CT prepares interventional cardiologists for the complexity of the procedure, influencing the choice of access and lesion preparation techniques. CT images aid in selecting appropriate materials, determining optimal views for stent deployment, and understanding lesion characteristics such as circumferential or long, thick or thin calcification. Moreover, CT helps assess the extent of atherosclerotic plaques, guiding stent length selection to cover the entire affected area.
CT-Guided PCI and Ongoing Clinical Trials
The use of CT for PCI planning has led to the development of trial protocols comparing CT-guided PCI with intravascular imaging-guided PCI, such as intravascular ultrasound (IVUS). The P4 trial, a randomized clinical trial, aims to enroll over 1,000 patients with significant coronary artery disease to evaluate the benefits of CT-guided PCI. The trial focuses on improving clinical outcomes, especially in diffuse diseases, where physiology-driven strategies guided by CT can provide valuable insights. The trial also emphasizes the importance of optimal lesion preparation for calcified plaques, as well as the preservation of side branches. These trials are expected to enhance awareness and utilization of CT in PCI procedures, potentially leading to improved patient outcomes.
In this episode of the Heart podcast, Digital Media Editor, Professor James Rudd, is joined by Dr Carlos Collet from Aalst, Belgium. They discuss how CT imaging can help all aspects of PCI. If you enjoy the show, please leave us a podcast review at https://itunes.apple.com/gb/podcast/heart-podcast/id445358212?mt=2 or wherever you get your podcasts - it's really helpful.
