In vivo assessment of bifurcation optimal viewing angles and bifurcation angles by three-dimensional (3D) quantitative coronary angiography.
In vivo assessment of bifurcation optimal viewing angles and bifurcation angles by three-dimensional (3D) quantitative coronary angiography.
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通过三维（3D）定量冠状动脉造影对分叉的最佳视角和分叉角度的分叉评估。
DOI：
10.1007/s10554-011-9996-x
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发表时间：
2012-10
影响因子：
2.1
通讯作者：
Reiber, Johan H. C.
中科院分区：
文献类型：
--
作者：
Tu, Shengxian;Jing, Jing;Holm, Niels R.;Onsea, Kevin;Zhang, Tao;Adriaenssens, Tom;Dubois, Christophe;Desmet, Walter;Thuesen, Leif;Chen, Yundai;Reiber, Johan H. C.
关键词：
冠状动脉分叉病变的评价和支架植入术可能受益于最佳的血管造影视图。解剖学定义的分叉最佳视角（ABOVA）的特征在于具有分叉的正交视图，从而最大限度地减少开口处的重叠和透视缩短。然而，由于X射线系统的机械限制，C形臂无法达到某些深角度，因此，必须使用次佳或所谓的可获得分叉最佳视角（OBOVA）作为替代方案。本研究使用3D定量冠状动脉造影评估了典型患者人群中ABOVA和OBOVA的分布。此外，对四种主要冠状动脉分叉的分叉角度进行了评估和比较。阻塞性冠状动脉分叉病变患者纳入本多中心登记研究。应用一种新的、经过验证的三维QCA软件包重建分叉并计算三维分叉角。软件还自动提出了包括ABOVA在内的最佳视角候选列表。在下一步中，操作员选择最佳视角作为OBOVA，同时应用新的重叠预测方法以确保目标分叉和其他主要冠状动脉之间没有重叠。共评估了181例患者的194处分叉。56.7%的病例无法达到ABOVA; LM/LAD/LCx、LAD/Diagonal、LCx/OM和PDA/PLA分别为40例（81.6%）、40例（78.4%）、9例（17.6%）和21例（48.8%）。ABOVA和OBOVA分布稀疏，变异范围大：LM/LAD/LCx，5 ± 33 RAO，47 ± 35尾侧对4 ± 39 LAO，35 ± 16尾侧，LAD/Diagonal，4 ± 38 RAO，50 ± 14颅侧对14 ± 28 LAO，33 ± 5颅侧; LCx/OM，21 ± 32 LAO，27 ± 17尾侧vs 18 ± 31 LAO，25 ± 13尾侧; PDA/PLA，34 ± 21 LAO，36 ± 21颅侧vs 28 ± 25 LAO，29 ± 15颅侧。LM/LAD/LCx的近端分叉角最小（128° ± 24°），远端分叉角最大（80° ± 21°），而LAD/Diagonal（151° ± 13 °和48° ± 16 °）、LCx/OM（146° ± 18 °和57° ± 16°）和PDA/PLA（145° ± 19°和59° ± 17°）的近端分叉角最小。总之，所有主要冠状动脉分叉的最佳视角存在较大的变异性。由于当前X射线系统的机械限制，在大约一半的情况下无法在体内达到解剖学定义的分叉最佳视角。应提供一个可供选择或次佳的最佳观察角度。左主分叉处的分叉角变异性最大。
Evaluation and stenting of coronary bifurcation lesions may benefit from optimal angiographic views. The anatomy-defined bifurcation optimal viewing angle (ABOVA) is characterized by having an orthogonal view of the bifurcation, such that overlap and foreshortening at the ostium are minimized. However, due to the mechanical constraints of the X-ray systems, certain deep angles cannot be reached by the C-arm. Therefore, second best or, so-called obtainable bifurcation optimal viewing angle (OBOVA) has to be used as an alternative. This study assessed the distributions of ABOVA and OBOVA using 3D quantitative coronary angiography in a typical patient population. In addition, the bifurcation angles in four main coronary bifurcations were assessed and compared. Patients with obstructive coronary bifurcation disease were included in this multicenter registry. A novel and validated 3D QCA software package was applied to reconstruct the bifurcations and to calculate the bifurcation angles in 3D. A list of optimal viewing angle candidates including ABOVA was also automatically proposed by the software. In a next step, the operator selected the best viewing angle as OBOVA, while applying a novel overlap prediction approach to assure no overlap between the target bifurcation and other major coronary arteries. A total of 194 bifurcations from 181 patients were assessed. The ABOVA could not be reached in 56.7% of the cases; being 40 (81.6%), 40 (78.4%), 9 (17.6%), and 21 (48.8%) cases for LM/LAD/LCx, LAD/Diagonal, LCx/OM, and PDA/PLA, respectively. Both ABOVA and OBOVA distributed sparsely with large ranges of variance: LM/LAD/LCx, 5 ± 33 RAO, 47 ± 35 Caudal versus 4 ± 39 LAO, 35 ± 16 Caudal; LAD/Diagonal, 4 ± 38 RAO, 50 ± 14 Cranial versus 14 ± 28 LAO, 33 ± 5 Cranial; LCx/OM, 21 ± 32 LAO, 27 ± 17 Caudal versus 18 ± 31 LAO, 25 ± 13 Caudal; PDA/PLA, 34 ± 21 LAO, 36 ± 21 Cranial versus 28 ± 25 LAO, 29 ± 15 Cranial. LM/LAD/LCx had the smallest proximal bifurcation angle (128° ± 24°) and the largest distal bifurcation angle (80° ± 21°), as compared with LAD/Diagonal (151° ± 13º and 48° ± 16º), LCx/OM (146° ± 18º and 57° ± 16°), and PDA/PLA (145° ± 19° and 59° ± 17°). In conclusion, large variabilities in optimal viewing angles existed for all main coronary bifurcations. The anatomy-defined bifurcation optimal viewing angle could not be reached in vivo in roughly half of the cases due to the mechanical constraints of the current X-ray systems. Obtainable bifurcation optimal viewing angle should be provided as an alternative or second best. The bifurcation angles in the left main bifurcation demonstrated the largest variabilities.
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影响因子：
2.1
作者：
Tu, Shengxian;Koning, Gerhard;Jukema, Wouter;Reiber, Johan H. C.
通讯作者：
Reiber, Johan H. C.
影响因子：
11.3
作者：
Girasis, Chrysafios;Serruys, Patrick W.;Morice, Marie-Claude
通讯作者：
Morice, Marie-Claude
影响因子：
24
作者：
Iakovou, I;Ge, L;Colombo, A
通讯作者：
Colombo, A
影响因子：
6.7
作者：
Pflederer, Tobias;Ludwig, Josef;Achenbach, Stephan
通讯作者：
Achenbach, Stephan
影响因子：
2.1
作者：
Tuinenburg, Joan C.;Koning, Gerhard;Reiber, Johan H. C.
通讯作者：
Reiber, Johan H. C.