Jonathon Leipsic, MD, FRCPC, MSCCT, chairman of the Department of Radiology, University of British Columbia, explains how noninvasive computed tomography angiography (CTA) can be used to aid in planning interventional cardiology procedures in the coronaries. He spoke on the topic at the Society of Cardiovascular Computed Tomography (SCCT) 2022 meeting in July.
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.
"It's 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.
Leipsic was a co-author on a new 2022 SCCT expert consensus statement that CCTA provides specialists with an effective tool in the preparation and optimization of coronary procedures. Read more.
Related SCCT and Cardiac CT Content:
VIDEO: Use of CT to assess coronary plaques — Interview with Leslee Shaw, PhD
VIDEO: Top 6 takeaways from the Society of Cardiovascular CT 2022 meeting — interview with Eric Williamson, MD
VIDEO: The new role of cardiac CT under the 2021 chest pain evaluation guidelines — Interview with Eric Williamson, MD
VIDEO: Cardiac CT now recommended as a front-line chest pain assessment tool — Interview with Leslee Shaw, PhD
VIDEO: Office-based cardiac CT and FFR-CT offer a new business model
VIDEO: The new role of cardiac CT in chest pain evaluation — Interview with Brian Ghoshhajra, MD
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com