Comparison of fluoroscopic coronary angiography and multi-slice coronary angiography in the characterization of anomalous coronary artery.

Anomalous coronary arteries with an inter-arterial course are associated with sudden cardiac death. We reported a study comparing the accuracy of fluoroscopic coronary angiography (FCA) with that of multi-slice computed tomography (MSCT) coronary angiography in determining the proximal course of anomalous coronary arteries. Twelve patients with thirteen anomalous coronary arteries had both FCA and MSCT coronary angiography were included in this study. Twelve cardiologists individually reviewed FCAs of anomalous coronary arteries and determined the proximal course of anomalous coronary arteries as retro-aortic, inter-arterial or ante-pulmonary. Their diagnoses were compared with MSCT coronary angiography which was regarded as the reference standard in this study. On MSCT coronary angiography, there were six anomalous left circumflex arteries with a retro-aortic course, five anomalous right coronary arteries and one anomalous left anterior descending artery with inter-arterial courses, and a single anomalous left main artery with an ante-pulmonary course. The percentage of correct diagnosis made by 12 cardiologists based on FCA findings was 93/156 or 60%. None of the cardiologists was correct in determining the proximal course of all anomalous coronary arteries. The median number of anomalous coronary arteries with their proximal courses correctly identified by the cardiologists was 7.5 (range 3-12). In conclusion, FCA was limited in delineating the proximal course of anomalous coronary arteries in comparison with MSCT coronary angiography.

CT coronary angiography predicts the outcome of percutaneous coronary intervention of chronic total occlusion.

BACKGROUND: The success rate of percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) is relatively low. Further evaluation of CTO lesion with CT coronary angiography (CT-CA) may help to better select patients that would benefit from percutaneous revascularization. We aimed to test the possible association between failed PCI and transluminal calcification of CTO as assessed by CT-CA. METHODS: Patients with CTO awaiting PCI were scanned with a 16-slice CT. A cardiologist and a radiologist assessed transluminal calcification of CTO lesions on CT images while an interventional cardiologist at a core laboratory assessed conventional variables of invasive fluoroscopic coronary angiography (FCA) associated with failed PCI of CTO. The significance of CT and FCA variables in association with failed PCI were analyzed. RESULTS: In a cohort of 39 patients with 43 CTO lesions, 24 lesions were successfully revascularized. Transluminal calcification > or =50% as assessed on CT-CA was strongly associated with failed PCI (odds ratio [OR] of PCI success = 0.10, 95% confidence interval [CI]: 0.02-0.47, P = 0.003). Blunt stump as seen on FCA was also associated with failed PCI (OR of PCI success = 0.24, 95% CI: 0.07-0.86, P = 0.029). There was no significant evidence to support that the duration of CTO, presence of side branch and bridging collaterals, and the absence of microchannels as assessed with FCA were associated with failed PCI. On multivariate analysis, transluminal calcification > or =50% on CT-CA was the only significant predictor of failed PCI. CONCLUSIONS: Heavy transluminal calcification as assessed with CT-CA is an independent predictor of failed PCI of CTO. CT-CA may have a role in the work-up of CTO patients prior to PCI.

Percutaneous revascularization of chronic total occlusions: review of the role of invasive and non-invasive imaging modalities.

Percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) has a lower success rate than PCI of non-occluded coronary stenosis. Failure to cross the occlusive lesion with a guide wire is the main cause of unsuccessful PCI of a CTO. Multi-imaging modalities may provide valuable information for PCI of CTO. This paper reviews the role of invasive and non-invasive imaging modalities such as intravascular ultrasound, optical coherent reflectometry, CT coronary angiography and cardiac magnetic resonance imaging in facilitating percutaneous coronary intervention of CTO.

Giant single coronary system with coronary cameral fistula diagnosed on MSCT.

Anomalous single coronary artery with coronary fistula is a rare finding. This is a case report of an unusual single coronary artery arising from left coronary sinus and terminating into right ventricle through a coronary cameral fistula to form a left to right shunt. This case report also illustrates how well the non-invasive CT coronary angiography with a 16-slice CT scanner characterizes the anatomy of anomalous coronary artery with a coronary cameral fistula.

Multislice CT to evaluate coronary stent patency: a case report.

This is a case report on the ability of 16-slice computed tomography in assessing the patency of coronary stent and diagnosing an asymptomatic stenotic lesion with soft plaque morphology. These findings were confirmed with a selective coronary angiography. Identification of lesion morphology facilitated our decision on prophylactic and direct stenting to the lesion.

Beginning angiography: a step-by-step guide.

Procedures in radiology are still very much learnt as an apprenticeship. While there is no substitute for hands-on practice and the one-to-one teaching of an experienced consultant, it has been our experience that learning is significantly facilitated by the availability of simple, easy-to-follow, relevant notes for pre-reading, especially in the difficult and potentially hazardous area of angiography. However, we have had surprising difficulty in finding an introductory text that is suitable for the teaching of angiography to new, never-seen-it-before trainees. We have therefore developed a short, simple, illustrated manual within our department for introducing angiography to first-year registrars, which we present in this article. We hope trainees will find it of use for providing an overview of the principles and the basic techniques involved prior to beginning formal training in this challenging and rewarding specialty.