Consensus document on the role of cardiac computed tomography for pre-procedural planning in minimally invasive percutaneous coronary intervention from the Japanese association of cardiovascular intervention and therapeutics

TL;DR

This paper discusses how cardiac CT improves planning for a minimally invasive heart procedure called slender PCI by providing detailed anatomical insights.

Contribution

The paper introduces a consensus on integrating cardiac CT into pre-procedural planning for slender PCI to enhance procedural success and safety.

Findings

Cardiac CT provides precise vessel measurements and identifies optimal landing zones for slender PCI.

CT helps predict risks in complex lesions like bifurcation and calcified plaque, guiding device selection.

A practical CT-guided pre-procedural checklist is proposed to optimize slender PCI workflows.

Abstract

Slender percutaneous coronary intervention (PCI) is a minimally invasive technique that uses smaller catheters, typically 5-French devices, to reduce bleeding complications and eliminate the need for unnecessarily large catheters. While these techniques are highly effective for non-complex lesions, they face inherent challenges, such as limitations in device compatibility and technical constraints. These challenges emphasize the importance of thorough pre-procedural planning to ensure optimal equipment selection and successful procedures. Cardiac computed tomography (CT) addresses these limitations by providing a comprehensive three-dimensional view of the coronary artery anatomy and lesion characteristics. This consensus statement outlines the role of cardiac CT in optimizing slender PCI strategies, emphasizing the importance of detailed anatomical assessments and advanced evaluations of lesion complexity. Cardiac CT enables precise measurements of vessel dimensions, identification of optimal landing zones, and accurate characterization of lesion complexity, including calcified plaque. Thin-slab maximum intensity projection reconstruction provides simultaneous longitudinal and cross-sectional views, comparable with findings of coronary angiography and intravascular imaging, facilitating interventional planning. For complex lesions, CT is essential. It accurately predicts the risk of side branch occlusion in bifurcation lesions, characterizes the distribution of calcification in heavily calcified lesions to aid in device selection, and helps in the appropriate selection of cases for chronic total occlusion lesions based on CT-derived scores and detailed morphological assessments. To systematically apply these principles, a practical pre-procedural checklist for CT-guided planning is proposed. The integration of cardiac CT into the slender PCI workflow extends beyond anatomical assessment to encompass the optimization of resource utilization, potentially enabling interventionists to proceed with appropriately minimally invasive techniques from the outset.

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