Pre-procedural combined coronary angiography and stress myocardial perfusion imaging using 320-detector CT in unprotecte
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CASE REPORT
Pre-procedural combined coronary angiography and stress myocardial perfusion imaging using 320-detector CT in unprotected left main and ostial left anterior descending artery intervention Brian S. Ko • Marcus Crossett • Sujith K. Seneviratne
Received: 28 April 2014 / Accepted: 21 July 2014 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2014
Abstract Pre-procedural anatomic and functional coronary assessment plays a crucial role in selection of patients suitable for unprotected left main percutaneous coronary intervention. Combined coronary computed tomography angiography and adenosine stress computed tomography myocardial perfusion imaging is a non-invasive technique which may provide this information. This is the first report describing its use to assist patient selection and procedural planning prior to elective left main and ostial left anterior descending artery coronary intervention. Keywords Myocardial ischemia Complex percutaneous coronary intervention Fractional flow reserve Abbreviations LM Left main coronary artery FFR Fractional flow reserve CCTA CT coronary angiography CTP CT stress myocardial perfusion imaging LAD Left anterior descending artery LCx Left circumflex coronary artery RCA Right coronary artery PCI Percutaneous coronary intervention Introduction Pre-procedural anatomic and functional coronary assessment plays a crucial role in selection of patients suitable for B. S. Ko (&) M. Crossett S. K. Seneviratne Monash Cardiovascular Research Centre, MonashHEART, Department of Medicine, Monash Medical Centre (MMC), Southern Health and Monash University, 246 Clayton Road, Clayton, VIC 3168, Australia e-mail: [email protected]
unprotected left main (LM) percutaneous coronary intervention (PCI). Combined coronary computed tomography angiography (CCTA) and adenosine stress computed tomography myocardial perfusion imaging (CTP) is a noninvasive technique which may provide this valuable information for patient selection and procedural planning.
Case report A 59-year-old diabetic woman with class III angina and suspected coronary artery disease underwent combined CCTA/CTP using prospective- ECG-gated 320-detector CT (Toshiba Medical Systems, Japan) targeting 70–90 % of the R–R interval. Resting CCTA is performed followed by stress CTP 20 min after following a 3-min intravenous adenosine infusion administered at a rate of 140 mg/kg/ min. Total radiation dose and volume of contrast used for the protocol was 7.7 mSv and 120 mls, respectively. Coronary computed tomography angiography (CCTA) demonstrated an eccentric mixed, calcified, and non-calcified, plaque which extended from the LM into the ostium and proximal left anterior descending artery (LAD) yet spared the ostium of the left circumflex (LCx) (Fig. 1). This resulted in at least moderate stenosis in the LM and likely severe stenosis in the proximal LAD though the blooming artifacts from the calcified plaque limited accurate assessment. There was no other plaque in the remaining LAD or LCx. There was a
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