Leipsic is a noted expert in use of cardiac CT for planning transcatheter structural heart interventions, but is also an advocate for wider CT use to plan percutaneous coronary intervention (PCI) and chronic total occlusion (CTO) procedures.
"Its quite analogous to using CT to plan a structural heart procedures, but still far too often our coronary interventional cardiology colleagues go into the cath lab without any information," explained Leipsic. "They know the patient has some symptoms and perhaps an equivocal stress test, but they don't know anything more than that, such as the extent of disease or what they are going to encounter. But given that the guidelines have shifted to a CT first strategy, more and more patients are going to have a CT and now it is about exploring how the CT can help plan coronary interventions to ensure more complete revascularization."
CT can bring not just anatomical information about the artery and the plaque, but also show vessel remodeling, offer information on plaque composition. It also offers functional information using virtual fractional flow reserve CT (FFR-CT), where FFR measurements can shown on a map off the entire coronary tree. He said this can help guide interventionists in planning without the need for using pressure wires in the cath lab. CT also can show the best viewpoints to see a specific coronary or lesion, which can help plan what angle the C-arm needs to be at to duplicate that view to save procedure time. CT also can enable stent sizing and give an idea of guide wires and other equipment needed prior to catheterizing the patient.
CT is already used in many other areas of medicine diagnose and qualify disease and plan procedures, and this is just the next logical step, he said.
"If you go in to take out an appendix, you don't do an exploratory laparotomy, you do a CT," Leipsic said. "You confirm if there is appendicitis and then come up with a plan. The same is true of tumor imaging, or abdominal aortic aneurisms. So now we have a rich anatomical dataset for the coronaries that gives you lesion length, stenosis morphology, and it gives us an understanding on the morphology of the plaque. And with FFR-CT, we now have physiology that can help you understand the depth of the abnormality, the pattern of the physiology."
The most important thing is for people to understand how CT can help offer more information on patients and their disease beyond initial diagnosis, Leipsic said. With increasing use of cardiac CT, he said this is playing an increasing role in how interventionists operate.
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