Three-Dimensional CT for Preprocedural Planning of PCI for Ostial Right Coronary Artery Lesions: A Randomized Controlled Pilot Trial

BACKGROUND: Geographic stent-ostium mismatch is an important predictor of target lesion failure after percutaneous coronary intervention of an aorto-ostial right coronary artery lesion. Optimal visualization of the aorto-ostial plane is crucial for precise stent implantation at the level of the ostium. This study investigates whether preprocedural 3-dimensional computed tomography (3DCT), with determination of the optimal viewing angle, would allow for more precise stent implantation and reduce procedure time, contrast, and radiation dose. METHODS: In this single-center, prospective, open-label, core-laboratory blinded trial, a total of 30 patients with an aorto-ostial right coronary artery lesion were randomly assigned to either percutaneous coronary intervention with a preprocedural 3DCT or angiography-guided percutaneous coronary intervention. The optimal working view angle was determined by 3DCT in the intervention group and by the operators’ discretion in the control group. The primary end point was the percentage of patients without geographic mismatch, as determined by intravascular ultrasound. RESULTS: 3DCT-determined C-arm angles were heterogenous but, in general, more extreme left anterior oblique projections were used (P<0.0001). While stent implantation was in the optimal position in all patients randomized to the intervention group, geographic mismatch was present in 5 (33%) patients randomized to the control group (P=0.06). The mean amount of procedural contrast (P<0.0001), mean radiation (P=0.03), and median procedure time (P=0.03) were significantly lower in the intervention group. The 3DCT scan was able to predict the calcium arc (P<0.0001) and minimal lumen area by intravascular ultrasound (P=0.003). CONCLUSIONS: Preprocedural 3DCT planning for percutaneous coronary intervention of aorto-ostial right coronary artery lesions allows for optimal stent positioning while reducing procedure time, contrast, and radiation dose.