Coronary lesions quantification with dual-axis rotational coronary angiography




Abstract


Background


Coronary angiography (CA) has been the gold standard technique for studying coronary artery disease. It is based on the analysis of bidimensional orthogonal projections that may not be optimal to estimate determinate coronary segments. Rotational angiography “Xperswing” (DARCA) is a new technique that allows the visualization of the coronary arteries from multiple views, with a single contrast injection. The aim of this study is to evaluate the coronary lesions quantification with DARCA.


Methods


Quantitative coronary analysis of significant coronary stenosis (> 50%) was performed. Every lesion was measured in two different projections: the “optimal projection”, obtained by DARCA and defined by the operator as the one with a better lesion qualification, and the “standard projection”, corresponding to the usual projection closer to the optimal one in obliquity and angulation. Measures were performed twice and by two independent operators. Intra- and inter-observer correlation was estimated by Kappa index and variables were compared with t Student test (SPSS 14.0).


Results


205 lesions in 147 patients were analyzed. Kappa coefficient intra-observer was 0.80 and 0.86 respectively with an inter-observer correlation index of 0.72. Lesion length and maximal diameter of the vessel were significantly greater in the group of RA. In the segments analysis, calculated length was longer for the first diagonal branch, first marginal obtuse artery, middle circumflex, middle and distal RCA and posterior descending artery, with greater reference diameters for proximal LAD and distal RCA. There were no significant differences for coronary stenosis grade.


Conclusions


RA XperSwing provides a better visualization of coronary arteries improving lesions characterization, with longer measured lesions length and greater vessel diameters, especially in coronary segments with more angulation.



Background


Coronary angiography (CA) remains as the gold standard technique for the diagnosis and treatment of coronary lesions. It is carried out in multiple predefined bidimensional stationary views, at different angulations around the patient, and provides only a limited number of projections of the vascular tree despite the use of a considerable amount of contrast medium and radiation exposure. Over the years, studies of angioscopy and pathologic analysis have demonstrated the limited diagnostic accuracy of conventional angiography, especially in overlapped vessels and angulated segments .


Dual-axis rotational coronary angiography (DARCA) XperSwing® is an image acquisition technique in which the X-ray system swings around the patient mixing rotation and angulation during the acquisition of a single run. DARCA is available for systems with monoplane detector Allura Xper FD10 o FD 20 (Philips Medical Systems, The Netherlands) and provides different trajectories for the left and right coronary arteries using a rapid isocentric rotation of the imaging camera. The rotational representation of the coronary tree allows a better three-dimensional understanding of the spatial relationships of coronary tree branches compared to the traditional CA . XperSwing contains 7 different trajectories for equipment FD 10 and 6 for equipment FD 20 ( Fig. 1 and Table 1 ). With this system, the complete study may be performed with a total contrast amount of 35 ml, acquiring 149 images (87 for left coronary artery and 62 for right coronary artery) with an exposure time of 9.9 s (considering exclusively the acquisition phase) ( Fig. 2 ).




Fig. 1


Dual axis trajectories for coronary angiography of left coronary artery and right coronary artery with XperSwing FD 20 system. Conventional projections used in standard CA are marked with asterisks *. “Standard projections” corresponding to the DARA rotation close to the habitual projections are marked with + .


Table 1

Lesions quantification in analyzed segments.




































































































































































































































































































































































































































Optimal projection Standard projection P
Global measures
Minimum lumen diameter (mm) 1.13 ± 0.39 1.17 ± 0.47 0.33
Lesion length (mm) 9.74 ± 2.55 7.83 ± 2.81 0.01
Maximal lumen diameter (mm) 3.39 ± 0.49 3.21 ± 0.58 0.00
% Diameter 50.97 ± 10.70 49.05 ± 11.58 0.11
% Stenosis 82.29 ± 9.07 81.58 ± 7.67 0.46
Left main (6)
Length 9.21 ± 1.71 8.85 ± 1.95 0.69
Maximal lumen diameter 4.34 ± 0.58 4.16 ± 0.37 0.18
Minimum lumen diameter 1.76 ± 0.41 1.61 ± 0.51 0.87
% Diameter 42.34 ± 8.93 41.92 ± 9.75 0.94
% Stenosis 66.54 ± 8.49 65.87 ± 8.58 0.89
Proximal LAD (26)
Length 9.09 ± 2.53 8.93 ± 2.38 0.13
Maximal lumen diameter 3.54 ± 0.31 3.11 ± 0.60 0.01
Minimum lumen diameter 1.02 ± 0.74 1.20 ± 0.62 0.78
% Diameter 62.50 ± 7.20 63.28 ± 8.93 0.69
% Stenosis 84.92 ± 8.28 86.49 ± 7.39 0.39
Middle LAD (29)
Length 9.54 ± 2.28 8.72 ± 3.66 0.06
Maximal lumen diameter 3.55 ± 0.42 3.56 ± 0.44 0.61
Minimum lumen diameter 1.06 ± 0.29 1.15 ± 0.33 0.87
% Diameter 53.87 ± 8.39 54.31 ± 5.90 0.57
% Stenosis 86.82 ± 7.49 86.97 ± 6.79 0.73
Distal LAD (16)
Length 8.02 ± 0.49 6.98 ± 1.60 0.15
Maximal lumen diameter 3.17 ± 0.48 2.96 ± 0.14 0.12
Minimum lumen diameter 0.86 ± 0.31 0.97 ± 0.65 0.49
% Diameter 59.38 ± 6.10 61.38 ± 7.39 0.38
% Stenosis 95.47 ± 5.29 98.69 ± 6.59 0.43
First diagonal branch (8)
Length 10.02 ± 0.56 7.98 ± 1.60 0.00
Maximal lumen diameter 2.88 ± 0.23 2.76 ± 0.48 0.21
Minimum lumen diameter 0.79 ± 0.36 0.68 ± 0.38 0.44
% Diameter 57.51 ± 5.31 56.89 ± 6.92 0.51
%Stenosis 91.64 90.04 0.19
Proximal Cx (23)
Length 9.43 ± 2.52 9.19 ± 2.67 0.74
Maximal lumen diameter 4.02 ± 0.41 4.12 ± 0.28 0.81
Minimum lumen diameter 1.87 ± 0.59 1.59 ± 0.49 0.23
% Diameter 45.21 ± 5.27 47.58 ± 3.89 0.68
% Stenosis 72.35 ± 6.29 75.56 ± 7.36 0.42
Middle Cx (20)
Length 9.79 ± 1.64 6.08 ± 0.56 0.00
Maximal lumen diameter 3.39 ± 0.22 3.24 ± 0.44 0.19
Minimum lumen diameter 1.49 ± 0.32 1.59 ± 0.39 0.32
% Diameter 52.29 ± 4.58 61.29 ± 5.69 0.11
% Stenosis 85.21 ± 5.29 98.07 ± 9.28 0.09
Distal Cx (8)
Length 9.68 ± 1.51 8.64 ± 1.28 0.08
Maximal lumen diameter 3.16 ± 0.44 2.99 ± 0.32 0.43
Minimum lumen diameter 1.04 ± 0.38 0.98 ± 0.59 0.49
% Diameter 51.24 ± 5.39 53.29 ± 8.39 0.39
% Stenosis 82.29 ± 3.30 85.69 ± 6.12 0.65
Marginal obtuse branch (12)
Length 11.02 ± 2.52 8.19 ± 2.67 0.00
Maximal lumen diameter 2.98 ± 0.43 2.91 ± 0.29 0.81
Minimum lumen diameter 0.99 ± 0.29 1.13 ± 0.48 0.66
% Diameter 50.98 ± 5.38 51.49 ± 5.99 0.41
%Stenosis 83.29 ± 7.29 84.98 ± 6.39 0.34
Proximal RCA (8)
Length 9.22 ± 1.79 8.65 ± 1.35 0.06
Maximal lumen diameter 3.97 ± 0.46 3.70 ± 0.29 0.11
Minimum lumen diameter 1.57 ± 0.39 1.63 ± 0.38 0.73
% Diameter 47.39 ± 3.73 49.82 ± 4.38 0.38
% Stenosis 75.57 ± 8.25 78.78 ± 7.36 0.44
Middle RCA (21)
Length 10.93 ± 2.96 7.65 ± 2.37 0.00
Maximal lumen diameter 3.67 ± 0.33 3.56 ± 0.42 0.11
Minimum lumen diameter 1.37 ± 0.48 1.43 ± 0.29 0.62
% Diameter 49.58 ± 4.48 51.32 ± 2.49 0.45
% Stenosis 79.71 ± 3.93 82.51 ± 3.12 0.21
Distal RCA (12)
Length 9.89 ± 2.15 8.73 ± 2.52 0.01
Maximal lumen diameter 2.87 ± 0.37 2.52 ± 0.29 0.03
Minimum lumen diameter 1.12 ± 0.39 1.19 ± 0.48 0.67
% Diameter 49.87 ± 4.19 51.21 ± 5.60 0.30
% Stenosis 80.18 ± 7.12 82.336.89 0.65
Posterolateral artery (6)
Length 8.89 ± 1.98 7.21 ± 1.46 0.06
Maximal lumen diameter 2.77 ± 0.37 2.62 ± 0.29 0.45
Minimum lumen diameter 0.78 ± 0.28 0.93 ± 0.16 0.79
% Diameter 59.21 ± 2.15 62.38 ± 7.39 0.41
% Stenosis 95.02 ± 5.49 99.03 ± 6.59 0.38
Posterior descending artery (10)
Length 10.85 ± 2.53 8.84 ± 2.27 0.01
Maximal lumen diameter 2.69 ± 0.27 2.67 ± 0.26 0.82
Minimum lumen diameter 0.89 ± 0.31 0.72 ± 0.59 0.57
% Diameter 50.31 ± 5.46 49.29 ± 6.99 0.48
% Stenosis 80.89 ± 7.89 79.37 ± 6.25 0.41

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Nov 14, 2017 | Posted by in CARDIOLOGY | Comments Off on Coronary lesions quantification with dual-axis rotational coronary angiography
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