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Diagnostic and Interventional Radiology... 2012In this review, we aimed to outline the clinical and pathological conditions for which multidetector computed tomography coronary angiography (MDCT-CA) should be the... (Comparative Study)
Comparative Study Review
In this review, we aimed to outline the clinical and pathological conditions for which multidetector computed tomography coronary angiography (MDCT-CA) should be the preferred method because of its advantages over conventional coronary angiography (CCA). A consistent body of literature suggests that MDCT-CA is more than just complementary to CCA and that it provides more valuable diagnostic information in certain clinical situations, such as complex coronary artery variations, aorto-ostial lesions, follow-up of bypass grafts, myocardial bridging, coronary artery fistulas, aortic and coronary artery dissections, and cases in which the coronary ostia cannot be cannulated by a catheter because of massive atherosclerosis or extremely tortuous vascular structures.
Topics: Coronary Angiography; Coronary Artery Disease; Humans; Tomography, X-Ray Computed
PubMed: 22261852
DOI: 10.4261/1305-3825.DIR.5064-11.1 -
Current Cardiology Reports Sep 2019Spontaneous coronary artery dissection (SCAD) is a serious non-atherosclerotic disease, most frequently presenting as an acute coronary syndrome and affecting female... (Review)
Review
PURPOSE OF REVIEW
Spontaneous coronary artery dissection (SCAD) is a serious non-atherosclerotic disease, most frequently presenting as an acute coronary syndrome and affecting female patients. Considering that diagnosis of SCAD is often elusive, and its interventional treatment is associated to a higher rate of complications than obstructive atherosclerotic disease, we aim to review all the imaging tools currently available for the optimal diagnosis and treatment of this condition.
RECENT FINDINGS
The developments in both invasive and non-invasive imaging alternatives to coronary angiography, such as intravascular ultrasound, optical coherence tomography, and computed coronary angiography, have largely contributed to appraise the epidemiology of SCAD, understand its causative pathophysiological mechanisms, and improve our ability to confirm doubtful cases of SCAD. Intracoronary imaging is also a valuable in deciding the best therapeutic approach and in guiding interventions in those patients requiring percutaneous treatment. Furthermore, non-invasive imaging is a key tool in ruling out significant extracoronary vascular abnormalities which frequently occur in patients with underlying conditions like fibromuscular dysplasia who develop SCAD. Main imaging tools employed in SCAD cases could have advantages and drawbacks. Focusing on different types of SCAD, operators should be able to choose the best imaging technique for diagnosis, management, and follow-up.
Topics: Coronary Angiography; Coronary Vessel Anomalies; Female; Humans; Tomography, Optical Coherence; Vascular Diseases
PubMed: 31482436
DOI: 10.1007/s11886-019-1202-0 -
Scanning 2022To investigate the clinical benefits of coronary CT angiography in older adults. The results of this trial were 110 patients who underwent CT angiography (selected from... (Clinical Trial)
Clinical Trial
To investigate the clinical benefits of coronary CT angiography in older adults. The results of this trial were 110 patients who underwent CT angiography (selected from 20 March 2016 to 20 March 2017). Use computer group mode. The control group received health care, including 50 patients, and the control group received usual care, including 60 patients. Then, the best and best image quality, time-consuming analysis, and satisfaction were compared between the two groups. The experimental results showed that the best and best image quality (83.00%), examination time (5.72 ± 1.81) minutes, and patient satisfaction (100.00%) of the experimental group were better than those of the control group ( < 0.05). Targeted healthcare for patients undergoing coronary CT angiography can improve the patient's ability to receive a diagnosis with a consistent attitude, reduce work hours, reduce adverse factors, and improve patient satisfaction with care.
Topics: Aged; Computed Tomography Angiography; Coronary Angiography; Humans; Tomography, X-Ray Computed
PubMed: 35822159
DOI: 10.1155/2022/3663285 -
Discovery Medicine 2022Fractional flow reserve (FFR) is a gold standard for the assessment of hemodynamic change during coronary stenosis, but it has several limitations such as high cost, the... (Review)
Review
Fractional flow reserve (FFR) is a gold standard for the assessment of hemodynamic change during coronary stenosis, but it has several limitations such as high cost, the requirement of invasive pressure wire, and adverse drug reactions, which limit the wide application of FFR in clinical practice. In contrast, quantitative flow ratio (QFR) is a recently developed method for rapid calculation of FFR through 3-dimensional quantitative coronary angiography without the use of vasodilators and pressure wire. In this review we provide an updated summary of the principle of QFR, the correlation between QFR and FFR, and current applications of QFR in clinical cardiology. In conclusion, QFR provides a platform for functional evaluation of coronary stenoses based on angiographic data without invasive procedures; further development and optimization of QFR techniques will expand the application of QFR in clinical cardiology, ranging from diagnosis to coronary intervention to cardiac surgery, and benefit more patients.
Topics: Humans; Coronary Angiography; Fractional Flow Reserve, Myocardial; Imaging, Three-Dimensional; Coronary Stenosis; Vasodilator Agents; Cardiology
PubMed: 36274241
DOI: No ID Found -
Einstein (Sao Paulo, Brazil) 2013Coronary computed tomography angiography (coronary CTA) is a powerful non-invasive imaging method to evaluate coronary artery disease. Nowadays, coronary CTA estimated...
Coronary computed tomography angiography (coronary CTA) is a powerful non-invasive imaging method to evaluate coronary artery disease. Nowadays, coronary CTA estimated effective radiation dose can be dramatically reduced using state-of-the-art scanners, such as 320-row detector CT (320-CT), without changing coronary CTA diagnostic accuracy. To optimize and further reduce the radiation dose, new iterative reconstruction algorithms were released recently by several CT manufacturers, and now they are used routinely in coronary CTA. This paper presents our first experience using coronary CTA with 320-CT and the Adaptive Iterative Dose Reduction 3D (AIDR-3D). In addition, we describe the current indications for coronary CTA in our practice as well as the acquisition standard protocols and protocols related to CT application for radiation dose reduction. In conclusion, coronary CTA radiation dose can be dramatically reduced following the "as low as reasonable achievable" principle by combination of exam indication and well-documented technics for radiation dose reduction, such as beta blockers, low-kV, and also the newest iterative dose reduction software as AIDR-3D.
Topics: Coronary Angiography; Coronary Artery Disease; Humans; Multidetector Computed Tomography; Radiation Dosage; Radiographic Image Interpretation, Computer-Assisted
PubMed: 24136773
DOI: 10.1590/s1679-45082013000300025 -
Cardiovascular Intervention and... Apr 2020Quantitative coronary angiography (QCA) remains to play an important role in clinical trials and post-marketing surveillance related to the safety and efficacy of new...
Quantitative coronary angiography (QCA) remains to play an important role in clinical trials and post-marketing surveillance related to the safety and efficacy of new PCI devices. In this document, the current standard methodology of QCA is summarized. In addition, its history, recent development and future perspectives are also reviewed.
Topics: Coronary Angiography; Coronary Stenosis; Fractional Flow Reserve, Myocardial; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Japan; Percutaneous Coronary Intervention
PubMed: 32125622
DOI: 10.1007/s12928-020-00653-7 -
Circulation. Cardiovascular Quality and... May 2022Prior studies of radial access for cardiac catheterization have focused on early adopters of the technique, and some have described a risk/treatment paradox of low...
BACKGROUND
Prior studies of radial access for cardiac catheterization have focused on early adopters of the technique, and some have described a risk/treatment paradox of low radial access use among high bleeding risk patients. This study aimed to determine (1) trends in radial access use over time, (2) if increasing use of radial access is driven by new invasive and interventional cardiologists (operators) or existing operators changing their practice, and (3) if increasing radial rates are associated with lower bleeding rates and elimination of the risk/treatment paradox.
METHODS
In this cross-sectional study using data from the Clinical Assessment, Reporting, and Tracking Program, we calculated radial access rates and risk-adjusted postprocedural bleeding rates of patients undergoing diagnostic angiography or percutaneous coronary intervention (PCI) between 2011 and 2018 in Veterans Affairs hospitals. We used separate bleeding risk models for diagnostic angiography and PCI and assessed temporal trends with the Kendall Tau-b test.
RESULTS
Among 253 179 diagnostic angiograms and 93 614 PCIs, radial access rates increased over time for both diagnostic (17.5%-60.4%; <0.01)) and PCI procedures (14.0%-51.8%; <0.01). Existing operators and new operators increased their use at similar rates, but new operators entered practice with higher baseline rates. Nearly all operators used radial access at least once in 2018. Overall adjusted rates of bleeding declined, a trend that was significant for diagnostic angiography (2.4%-1.4%, =0.02) but not PCI (3.4%-2.5%, =0.20). Femoral access patients had a higher predicted risk for bleeding.
CONCLUSIONS
A steady rise in radial access for diagnostic angiography and PCI was driven by increasing use among existing operators and high use by new operators. While this was associated with decreasing bleeding rates, a risk/treatment paradox for access site selection persists; patients at higher bleeding risk were still more likely to receive femoral access.
Topics: Coronary Angiography; Cross-Sectional Studies; Hemorrhage; Humans; Percutaneous Coronary Intervention; Radial Artery; Risk Factors; Treatment Outcome
PubMed: 35272504
DOI: 10.1161/CIRCOUTCOMES.121.008359 -
Heart (British Cardiac Society) Nov 2008Coronary artery disease (CAD) is a major cause of mortality and ill health. (Meta-Analysis)
Meta-Analysis Review
CONTEXT
Coronary artery disease (CAD) is a major cause of mortality and ill health.
OBJECTIVE
To assess whether 64-slice CT angiography might replace some coronary angiography (CA) for diagnosis and assessment of CAD.
DATA SOURCES
Electronic databases, conference proceedings and reference lists of included studies.
STUDY SELECTION
Eligible studies compared 64-slice CT with a reference standard of CA in adults with suspected/known CAD, reporting sensitivity and specificity or true and false positives and negatives.
DATA EXTRACTION
Two reviewers independently extracted data from included studies.
RESULTS
Forty studies were included; 28 provided sufficient data for inclusion in the meta-analyses, all using a cut off point of >/=50% stenosis to define significant CAD. In patient-based detection (n = 1286) 64-slice CT pooled sensitivity was 99% (95% credible interval (CrI) 97% to 99%), specificity 89% (95% CrI 83% to 94%), median positive predictive value (PPV) across studies 93% (range 64-100%) and negative predictive value (NPV) 100% (range 86-100%). In segment-based detection (n = 14 199) 64-slice CT pooled sensitivity was 90% (95% CrI 85% to 94%), specificity 97% (95% CrI 95% to 98%), median PPV across studies 76% (range 44-93%) and NPV 99% (range 95-100%).
CONCLUSIONS
64-Slice CT is highly sensitive for patient-based detection of CAD and has high NPV. An ability to rule out significant CAD means that it may have a role in the assessment of chest pain, particularly when the diagnosis remains uncertain despite clinical evaluation and simple non-invasive testing.
Topics: Aged; Calcinosis; Chest Pain; Coronary Angiography; Coronary Artery Disease; Female; Humans; Male; Middle Aged; Radiographic Image Enhancement; Sensitivity and Specificity; Tomography, X-Ray Computed
PubMed: 18669550
DOI: 10.1136/hrt.2008.145292 -
Heart (British Cardiac Society) Nov 2005Is technology about to deliver on the long awaited goal of effective non-invasive methods for visualising and assessing coronary arteries?
Is technology about to deliver on the long awaited goal of effective non-invasive methods for visualising and assessing coronary arteries?
Topics: Contrast Media; Coronary Angiography; Coronary Artery Disease; Forecasting; Humans; Tomography, X-Ray Computed
PubMed: 16230434
DOI: 10.1136/hrt.2004.058164 -
Journal of Comparative Effectiveness... Mar 2013Cardiac catheterization and coronary intervention via the radial approach is increasingly adopted as the preferred vascular access to avoid transfemoral vascular... (Comparative Study)
Comparative Study Meta-Analysis
Cardiac catheterization and coronary intervention via the radial approach is increasingly adopted as the preferred vascular access to avoid transfemoral vascular complications. Recent clinical trials have confirmed that radial access reduces vascular complications and local bleeding with similar procedural efficacy. Transradial access has inherent technical challenges, including smaller vessel size of the radial artery, arterial spasm and tortuosity involving the radial and subclavian arteries, which may undermine the procedural success of this approach. A number of strategies have been reported to minimize complications of radial access, including the use of hydrophilic introducer sheaths and smaller sheath sizes, administration of nitroglycerin and unfractionated heparin during the procedure, patent hemostasis of the radial artery and careful patient selection. Operators experienced in transradial percutaneous coronary intervention can achieve comparable clinical outcomes to the transfemoral approach and minimize vascular complications. Radial artery access is likely to become widely accepted as the preferred percutaneous coronary intervention approach.
Topics: Arterial Occlusive Diseases; Coronary Angiography; Coronary Artery Bypass; Femoral Artery; Humans; Learning Curve; Myocardial Infarction; Patient Preference; Percutaneous Coronary Intervention; Radial Artery; Randomized Controlled Trials as Topic; Spasm; Stroke
PubMed: 24236557
DOI: 10.2217/cer.12.79