Optimal Fluoroscopic Projections of Coronary Ostia and Bifurcations Defined by Computed Tomographic Coronary Angiography

ABSTRACT Objectives This study aims to define the optimal fluoroscopic viewing angles of both coronary ostia and important coronary bifurcations by using three-dimensional multi-slice computed tomography data. Background Optimal fluoroscopic projections are crucial for coronary imaging and interventions. Historically, coronary fluoroscopic viewing angles were derived empirically from experienced operators. Methods In this analysis, we studied 100 consecutive patients who underwent computed tomography coronary angiography (CTCA) for suspected coronary artery disease. We describe a CTCA-based method to define optimal viewing angles of both coronary ostia and important coronary bifurcations to guide percutaneous coronary interventions (PCI). Results The average optimal viewing angle for ostial left main stenting was LAO 37; CRA 22 (95% CI LAO 33-40, CRA 19-25) and for ostial right coronary stenting LAO 79; CRA 41 (95% CI LAO 74-84, CRA 37-45). Estimated mean optimal viewing angles for bifurcation stenting were as follows: left main - LAO 0; CAU 49 (95% CI RAO 8-LAO 8, CAU 43-54), left anterior descending with first diagonal branch - LAO 11; CRA 71 (95% CI RAO 6-LAO 27, CRA 66-77), left circumflex bifurcation with first marginal branch – LAO 24; CAU 33 (95% CI LAO 15-33, CAU 25-41) and posterior descending artery and posterolateral branch – LAO 44; CRA 34 (95% CI LAO 35-52 and CRA 27-41). Conclusions CTCA can suggest optimal fluoroscopic viewing angles of coronary artery ostia and bifurcations. As the frequency of use of diagnostic CTCA increases in the future, it has the potential to provide additional information for planning and guiding PCI procedures.