Efficacy of three-dimensional road mapping by fusion of computed tomography angiography and fluoroscopy in endovascular
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ORIGINAL ARTICLE
Efficacy of three‑dimensional road mapping by fusion of computed tomography angiography and fluoroscopy in endovascular treatment of aorto‑iliac chronic total occlusion Naoki Hayakawa1 · Satoshi Kodera2 · Noriyoshi Ohki3 · Sandeep Sakkya1 · Junji Kanda1 Received: 18 May 2020 / Accepted: 28 August 2020 © Springer Japan KK, part of Springer Nature 2020
Abstract The efficacy of multimodality image fusion road-mapping technique for endovascular therapy has been reported recently. Our aim was to evaluate the efficacy of endovascular therapy (EVT) with three-dimensional (3D) road mapping by fusing computed tomography (CT) and angiographical volumetric data for aorto-iliac chronic total occlusion (CTO). We retrospectively analyzed 36 patients with aorto-iliac CTO from June 2017 to November 2019 and classified them into two groups: EVT using a CT fused 3D roadmap (CTf3D-RM; 3D group, n = 14) and standard EVT (standard group, n = 22). Primary endpoint was wiring time and secondary endpoints were procedural success rate, number of guidewires, procedure time, radiation dose, contrast medium dose, and complications. Wiring time was significantly shorter in the 3D group than the standard group (3D, 15.6 ± 10.23 min vs. standard, 44.6 ± 35.3 min; p = 0.0052). Both groups had high procedural success rates (3D, 100% vs. standard, 100%) and low complication rates (3D, 0.0% vs. standard, 9.1%; p = 0.51). There were significantly fewer guidewires in the 3D group than the standard group (3D, 2.78 ± 1.31 vs. standard, 4.36 ± 2.01; p = 0.0138). The 3D group trended towards shorter procedural time (3D, 78.8 ± 32.5 min vs. standard, 107.5 ± 52.5 min; p = 0.076), lower radiation dose (3D, 28.6 ± 18.9 Gycm2 vs. standard, 48.9 ± 49.2 G ycm2; p = 0.15), and lower contrast medium dose (3D, 102.2 ± 30.6 vs. standard, 127.5 ± 51.3; p = 0.11) than the standard group. Therefore, we concluded that EVT with CTf3D-RM is effective for aorto-iliac CTO. This method may improve the quality of aorto-iliac CTO interventions. Keywords Endovascular therapy · Three-dimensional roadmap · Fusion imaging · Chronic total occlusion
Introduction The efficacy of endovascular therapy (EVT) for the aortoiliac artery is well established [1, 2]. However, some difficult cases remain, including a long chronic total occlusion (CTO). The passage of the guidewire is very important because once the guidewire is passed, a good result can be obtained by stent or stent graft implantation in aorto-iliac lesions. Additionally, as a fatal outcome caused by vascular * Naoki Hayakawa [email protected] 1
Department of Cardiovascular Medicine, Asahi General Hospital, I‑1326, Asahi, Chiba 289‑2511, Japan
2
Department of Cardiovascular Medicine, University of Tokyo Hospital, Tokyo, Japan
3
Department of Radiology, Asahi General Hospital, Asahi, Chiba, Japan
perforation or injury is possible in patients with aorto-iliac lesions, the guidewire should be passed through the most optimal route. Furthermore, there are some reports of pseudoaneurysm
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