1. MSCT integration for complex bifurcation Alice Ohanessian MC Morice, T. Lefevre, Y.Louvard ICPS, Massy France Institut Cardiovasculaire Paris Sud

2. CT integration for bifurcation background Tremendous improvement of Cardiac CT 64 slices CT Incredible perspectives New tool for facilitated coronary angioplasty ? Institut Cardiovasculaire Paris Sud

3. CT integration for bifurcation how ? New concept developped by manufacturers One or two screens dedicated to CT integrated in the cath lab Screens directely connected to a CT work station outside the cath lab Institut Cardiovasculaire Paris Sud

4. CT integration for bifurcation how does it work ? Cardiac CT is first performed in scan unit Images are post treated like usually Selected phases and images are then transfered to the CT work station in the cath lab unit Institut Cardiovasculaire Paris Sud

5. 1.From the CT work station 2.From the cath lab Institut Cardiovasculaire Paris Sud CT integration for bifurcation what can we do ?

6. CT integration for bifurcation 1. from the CT work station Institut Cardiovasculaire Paris Sud

7. CT integration for bifurcation 1. from the CT work station Coronary tree reconstruction select cardiac CT images define optimal view to display the lesion and plaque extension select the best angle to work during PCI Institut Cardiovasculaire Paris Sud

8. CT integration for bifurcation 1. from the CT work station Mesure the true lesion length Appreciate the true shortening Plaque extension Anatomic relation with side branch Ostial lesion of side branch (bifurcation) Institut Cardiovasculaire Paris Sud

9. CT integration for bifurcation 2- from the cath lab Institut Cardiovasculaire Paris Sud

10. CT integration for bifurcation 2- from the cath lab Appreciate at the same time angiographic view and anatomic view Grant tube and CT images (3D, angio) synchronized Call the view previously selected No wasted contrast media in choosing the optimal view ( tube rotation makes rotate CT view) Institut Cardiovasculaire Paris Sud

11. CT integration for bifurcation Improvement for opertor Save procedural time Select best view without contrast or scopie Less irradiation Optimize PCI strategy Increase procedural success in complex PCI and complex anatomy Institut Cardiovasculaire Paris Sud

12. CT integration for bifurcation improvement for the patient Procedure is shorter Improve patient comfort Less contrast medium used Less renal failure Less irradiation: but MSCT irradiation Institut Cardiovasculaire Paris Sud

13. CT integration for bifurcation complex bifurcation: angio Institut Cardiovasculaire Paris Sud

14. CT integration for bifurcation complex bifurcation: MSCT Institut Cardiovasculaire Paris Sud

15. CT integration for bifurcation complex bifurcation: integration Institut Cardiovasculaire Paris Sud

16. CT integration for bifurcation PCI procedure Institut Cardiovasculaire Paris Sud

17. CT integration for bifurcation tube and 3D view synchronization Institut Cardiovasculaire Paris Sud

18. CT integration for bifurcation trifurcation result Institut Cardiovasculaire Paris Sud

19. CT integration for bifurcation conclusion MSCT integration in the cath lab is a new tool for interventional cardiologist Important improvement in the approach of complex PCI Shorter procedure, less contrast media Reserved to complex cases Dose modulation +++(3-5msv) Institut Cardiovasculaire Paris Sud