When is rotational angiography superior to conventional single-plane angiography for planning coronary angioplasty?

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Abstract

Objectives:

To investigate the value of rotational coronary angiography (RoCA) in the context of percutaneous coronary intervention (PCI) planning.

Background:

As a diagnostic tool, RoCA is associated with decreased patient irradiation and contrast use compared with conventional coronary angiography (CA) and provides superior appreciation of three-dimensional anatomy. However, its value in PCI remains unknown.

Methods:

We studied stable coronary artery disease assessment and PCI planning by interventional cardiologists. Patients underwent either RoCA or conventional CA pre-PCI for planning. These were compared with the referral CA (all conventional) in terms of quantitative lesion assessment and operator confidence. An independent panel reanalyzed all parameters.

Results:

Six operators performed 127 procedures (60 RoCA, 60 conventional CA, and 7 crossed-over) and assessed 212 lesions. RoCA was associated with a reduction in the number of lesions judged to involve a bifurcation (23 vs. 30 lesions,P< 0.05) and a reduction in the assessment of vessel caliber (2.8 vs. 3.0 mm,P< 0.05). RoCA improved confidence assessing lesion length (P= 0.01), percentage stenosis (P= 0.02), tortuosity (P< 0.04), and proximity to a bifurcation (P= 0.03), particularly in left coronary artery cases. X-ray dose, contrast agent volume, and procedure duration were not significantly different.

Conclusions:

Compared with conventional CA, RoCA augments quantitative lesion assessment, enhances confidence in the assessment of coronary artery disease and the precise details of the proposed procedure, but does not affect X-ray dose, contrast agent volume, or procedure duration. © 2015 Wiley Periodicals, Inc.

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