Plessis Julien, Warin Fresse Karine, Cahouch Zachary, Manigold Thibaut, Letocart Vincent, Le Gloan Laurianne, Guyomarch Béatrice, Guerin Patrice
Institut du Thorax, Service de Cardiologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
Institut du Thorax, Service de Cardiologie, Centre Hospitalier Universitaire de Nantes, Nantes, France.
J Am Heart Assoc. 2016 Jun 10;5(6):e002233. doi: 10.1161/JAHA.115.002233.
Coronary angiography is more complex in patients with coronary artery bypass grafts (CABG). Image fusion is a new technology that allows the overlay of a computed tomography (CT) three-dimension (3D) model with fluoroscopic images in real time.
This single-center prospective study included 66 previous CABG patients undergoing coronary and bypass graft angiography. Image fusion coronary angiographies (fusion group, 20 patients) were compared to conventional coronary angiographies (control group, 46 patients). The fusion group included patients for whom a previous chest CT scan with contrast was available. For patients in this group, aorta and CABG were reconstructed in 3D from CT acquisitions and merged in real time with fluoroscopic images. The following parameters were compared: time needed to localize the CABG; procedure duration; air kerma (AK); dose area product (DAP); and volume of contrast media injected. Results are expressed as median. There were no significant differences between the 2 groups in patient demographics and procedure characteristics (access site, number of bypass to be found, and interventional cardiologist's experience). The time to localize CABG was significantly shorter in the fusion group (7.3 versus 12.4 minutes; P=0.002), as well as the procedure duration (20.6 versus 25.6 minutes; P=0.002), AK (610 versus 814 mGy; P=0.02), DAP (4390 versus 5922.5 cGy·cm(2); P=0.02), and volume of iodinated contrast media (85 versus 116 cc; P=0.002).
3D image fusion improves the CABG detection in coronary angiography and reduces the time necessary to localize CABG, total procedure time duration, radiation exposure, and volume of contrast media.
冠状动脉搭桥术（CABG）患者的冠状动脉造影更为复杂。图像融合是一项新技术，可将计算机断层扫描（CT）三维（3D）模型与荧光透视图像实时叠加。
这项单中心前瞻性研究纳入了66例曾接受CABG且正在接受冠状动脉和搭桥血管造影的患者。将图像融合冠状动脉造影（融合组，20例患者）与传统冠状动脉造影（对照组，46例患者）进行比较。融合组纳入了有既往胸部增强CT扫描的患者。对于该组患者，从CT采集数据中重建主动脉和CABG的三维模型，并与荧光透视图像实时融合。比较以下参数：定位CABG所需时间、手术持续时间、空气比释动能（AK）、剂量面积乘积（DAP）以及注入的造影剂体积。结果以中位数表示。两组患者的人口统计学特征和手术特点（穿刺部位、需查找的搭桥血管数量以及介入心脏病专家的经验）无显著差异。融合组定位CABG的时间显著缩短（7.3分钟对12.4分钟；P = 0.002），手术持续时间也显著缩短（20.6分钟对25.6分钟；P = 0.002），AK（610对814 mGy；P = 0.02），DAP（4390对5922.5 cGy·cm²；P = 0.02）以及碘化造影剂体积（85对116 cc；P = 0.002）。
三维图像融合可改善冠状动脉造影中CABG的检测，并减少定位CABG所需时间、总手术时间、辐射暴露以及造影剂体积。
