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Singapore Medical Journal Mar 2020Computed tomography coronary angiography (CTCA) is a robust and reliable non-invasive alternative imaging modality to invasive coronary angiography, which is the... (Review)
Review
Computed tomography coronary angiography (CTCA) is a robust and reliable non-invasive alternative imaging modality to invasive coronary angiography, which is the reference standard in evaluating the degree of coronary artery stenosis. CTCA has high negative predictive value and can confidently exclude significant coronary artery disease (CAD) in low to intermediate risk patients. Over the years, substantial effort has been made to reduce the radiation dose and increase the cost efficiency of CTCA. In this review, we present the evolution of computed tomography scanners in the context of coronary artery imaging as well as its clinical applications and limitations. We also highlight the future directions of CTCA as a one-stop non-invasive imaging modality for anatomic and functional assessment of CAD.
Topics: Coronary Angiography; Coronary Artery Disease; Humans; Stents; Tomography, X-Ray Computed
PubMed: 32488269
DOI: 10.11622/smedj.2020028 -
Journal of the American College of... Mar 2018Transcatheter aortic valve replacement (TAVR) has revolutionized the management of patients with symptomatic severe aortic stenosis, and indications are expanding... (Review)
Review
Transcatheter aortic valve replacement (TAVR) has revolutionized the management of patients with symptomatic severe aortic stenosis, and indications are expanding towards treating younger patients with lower-risk profiles. Given the progressive nature of coronary artery disease and its high prevalence in those with severe aortic stenosis, coronary angiography and percutaneous coronary intervention will become increasingly necessary in patients after TAVR. There are some data suggesting that there are technical difficulties with coronary re-engagement, particularly in patients with self-expanding valves that, by design, extend above the coronary ostia. The authors review the challenges of coronary angiography and percutaneous coronary intervention post-TAVR and examine the geometric interactions between currently approved transcatheter aortic valves and coronary ostia, while providing a practical guide on how to manage these potentially complex situations.
Topics: Aortic Valve Stenosis; Clinical Trials as Topic; Coronary Angiography; Humans; Percutaneous Coronary Intervention; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 29566822
DOI: 10.1016/j.jacc.2018.01.057 -
Turk Kardiyoloji Dernegi Arsivi : Turk... Jun 2021
Topics: Arterial Occlusive Diseases; Coronary Angiography; Humans; Radial Artery; Ultrasonography, Interventional
PubMed: 34106057
DOI: 10.5543/tkda.2021.21114 -
JACC. Cardiovascular Interventions Oct 2016
Topics: Coronary Angiography; Radial Artery
PubMed: 27712734
DOI: 10.1016/j.jcin.2016.07.036 -
Journal of Nuclear Medicine : Official... May 2006Advances in multidetector CT (MDCT) technology with submillimeter slice collimation and high temporal resolution permit contrast-enhanced imaging of coronary arteries... (Review)
Review
Advances in multidetector CT (MDCT) technology with submillimeter slice collimation and high temporal resolution permit contrast-enhanced imaging of coronary arteries and coronary plaque during a single breath hold. Appropriate patient preparation, detailed technical and technological knowledge with regard to recognition of typical imaging artifacts (such as beam hardening or motion artifacts), and the adequate choice of postprocessing techniques to detect stenosis and plaque are prerequisites to achieving diagnostic image quality. A growing number of studies have suggested that 64-slice coronary CT angiography is highly accurate for the exclusion of significant coronary artery stenosis (>50% luminal narrowing), with negative predictive values of 97%-100%, in comparison with invasive selective coronary angiography. In addition, several studies have indicated that MDCT also can detect calcified and noncalcified coronary atherosclerotic plaques, especially in proximal vessel segments, showing a good correlation with intracoronary ultrasound. Studies on clinical utility, cost, and cost-effectiveness are now warranted to demonstrate whether and how this technique can change and improve the current management of patients with suspected or confirmed coronary artery disease.
Topics: Cardiology; Coronary Angiography; Coronary Stenosis; Cost-Benefit Analysis; Electrocardiography; Humans; Image Processing, Computer-Assisted; Time Factors; Tomography, X-Ray Computed; Ultrasonography
PubMed: 16644750
DOI: No ID Found -
The British Journal of Radiology May 2012Coronary CT angiography has been increasingly used in the diagnosis of coronary artery disease owing to rapid technological developments, which are reflected in the... (Review)
Review
Coronary CT angiography has been increasingly used in the diagnosis of coronary artery disease owing to rapid technological developments, which are reflected in the improved spatial and temporal resolution of the images. High diagnostic accuracy has been achieved with multislice CT scanners (64 slice and higher), and in selected patients coronary CT angiography is regarded as a reliable alternative to invasive coronary angiography. With high-quality coronary CT imaging increasingly being performed, patients can benefit from an imaging modality that provides a rapid and accurate diagnosis while avoiding an invasive procedure. Despite the tremendous contributions of coronary CT angiography to cardiac imaging, study results reported in the literature should be interpreted with caution as there are some limitations existing within the study design or related to patient risk factors. In addition, some attention must be given to the potential health risks associated with the ionising radiation received during cardiac CT examinations. Radiation dose associated with coronary CT angiography has raised serious concerns in the literature, as the risk of developing malignancy is not negligible. Various dose-saving strategies have been implemented, with some of the strategies resulting in significant dose reduction. The aim of this review is to present an overview of the role of coronary CT angiography on cardiac imaging, with focus on coronary artery disease in terms of the diagnostic and prognostic value of coronary CT angiography. Various approaches for dose reduction commonly recommended in the literature are discussed. Limitations of coronary CT angiography are identified. Finally, future directions and challenges with the use of coronary CT angiography are highlighted.
Topics: Coronary Angiography; Coronary Artery Disease; Humans; Multidetector Computed Tomography; Myocardial Perfusion Imaging; Myocardial Revascularization; Prognosis; Radiation Dosage; Risk; Stents
PubMed: 22253353
DOI: 10.1259/bjr/15296170 -
Journal of Interventional Cardiology 2020Percutaneous coronary intervention exposes patient and staff to ionizing radiation. Although staff only receive a small fraction of patient dose through scatter... (Review)
Review
BACKGROUND
Percutaneous coronary intervention exposes patient and staff to ionizing radiation. Although staff only receive a small fraction of patient dose through scatter radiation, there are concerns about the potential health effects of repeated exposure. Minimizing both patient and occupational exposure is needed.
OBJECTIVE
This article investigates patient and operator X-ray exposure over time in coronary intervention in relation to upgraded X-ray equipment, improved shielding, and enhanced operator awareness.
MATERIALS AND METHODS
Data regarding irradiation time, patient dose, and patient characteristics were extracted from the Norwegian Registry for Invasive Cardiology (NORIC) for procedures performed from 2013 to mid-2019. Personal operator dosimetry records were provided by the Norwegian Radiation and Nuclear Safety Authority. Improved operator shielding and awareness measures were introduced in 2018.
RESULTS
In the period 2013 through June 2019, 21499 procedures were recorded in our institution. Mean dose area product (DAP) for coronary angiography decreased 37% from 2981 Gy·m in 2013 to 1891 Gy·m in 2019 ( < 0.001). For coronary intervention, DAP decreased 39% from 8358 Gy·m to 5055 Gy·m. Personal dosimetry data indicate a 70% reduction in operator dose per procedure in 2019 compared to 2013. The most pronounced reduction occurred after improved radiation protection measures were implemented in 2018 (-48%).
CONCLUSIONS
This study shows a temporal trend towards considerable reduction in X-ray doses received by the patient and operator during cardiac catheterization. Upgraded X-ray equipment, improved shielding, and enhanced operator awareness are likely contributors to this development.
Topics: Coronary Angiography; Humans; Occupational Exposure; Percutaneous Coronary Intervention; Radiation Exposure; Radiologic Health
PubMed: 32934609
DOI: 10.1155/2020/9602942 -
Tidsskrift For Den Norske Laegeforening... Oct 2008Recent advances in computed tomography (CT) has made noninvasive imaging of the coronary arteries possible. Multidetector-CT (MDCT)-scanners capable of visualizing the... (Review)
Review
BACKGROUND
Recent advances in computed tomography (CT) has made noninvasive imaging of the coronary arteries possible. Multidetector-CT (MDCT)-scanners capable of visualizing the coronary arteries will be available in most Norwegian hospitals within a few years. If the examinations have acceptable quality, diagnostics of coronary pathology could to some extent be decentralized.
MATERIAL AND METHODS
Our overview is based on non-systematic review of relevant literature, as well as our own experience.
RESULTS AND DISCUSSION
Good results have been shown for 16 and especially for 64 detector scanners in several comparative studies with invasive coronary angiography. The predictive value of a negative test is impressive in all the published studies. Significant coronary pathology is unlikely with a normal MDCT investigation of good quality, but MDCT's imprecise assessment of stenoses generates too many false positive findings. CT-technology is evolving rapidly. Yet, variable image quality and a high radiation dose are still challenging, even with modern CT-scanners.
INTERPRETATION
We advocate against uncritical use of the method, however, there is reason for optimism regarding the method's future contribution to coronary diagnostics.
Topics: Coronary Angiography; Coronary Disease; Humans; Patient Selection; Predictive Value of Tests; Radiation Dosage; Tomography, X-Ray Computed
PubMed: 18846140
DOI: No ID Found -
Medical Image Analysis Aug 2016Despite continuous progress in X-ray angiography systems, X-ray coronary angiography is fundamentally limited by its 2D representation of moving coronary arterial trees,... (Review)
Review
Despite continuous progress in X-ray angiography systems, X-ray coronary angiography is fundamentally limited by its 2D representation of moving coronary arterial trees, which can negatively impact assessment of coronary artery disease and guidance of percutaneous coronary intervention. To provide clinicians with 3D/3D+time information of coronary arteries, methods computing reconstructions of coronary arteries from X-ray angiography are required. Because of several aspects (e.g. cardiac and respiratory motion, type of X-ray system), reconstruction from X-ray coronary angiography has led to vast amount of research and it still remains as a challenging and dynamic research area. In this paper, we review the state-of-the-art approaches on reconstruction of high-contrast coronary arteries from X-ray angiography. We mainly focus on the theoretical features in model-based (modelling) and tomographic reconstruction of coronary arteries, and discuss the evaluation strategies. We also discuss the potential role of reconstructions in clinical decision making and interventional guidance, and highlight areas for future research.
Topics: Algorithms; Clinical Decision-Making; Coronary Angiography; Coronary Vessels; Humans; Image Interpretation, Computer-Assisted
PubMed: 27054277
DOI: 10.1016/j.media.2016.02.007 -
Minerva Anestesiologica May 2019The role of emergency coronary angiography after cardiac arrest and return of spontaneous circulation is not yet completely clear. While patients with a high risk of... (Review)
Review
The role of emergency coronary angiography after cardiac arrest and return of spontaneous circulation is not yet completely clear. While patients with a high risk of acute coronary lesion and with a presumed favorable neurological outcome should undergo a coronary angiography as soon as possible, the decision to perform it is questionable in patients who are less likely to have a coronary cause of arrest, and when clinical characteristics raise serious concerns regarding neurological outcome. In this paper, we analyze the main advantages and drawbacks of a coronary angiogram after a successfully resuscitated cardiac arrest.
Topics: Cardiopulmonary Resuscitation; Coronary Angiography; Emergency Medical Services; Heart Arrest; Humans; Percutaneous Coronary Intervention
PubMed: 30735023
DOI: 10.23736/S0375-9393.19.13425-6