European Radiology

, Volume 27, Issue 6, pp 2464–2473 | Cite as

Real-time fusion of coronary CT angiography with x-ray fluoroscopy during chronic total occlusion PCI

  • Brian B. Ghoshhajra
  • Richard A. P. Takx
  • Luke L. Stone
  • Erin E. Girard
  • Emmanouil S. Brilakis
  • William L. Lombardi
  • Robert W. Yeh
  • Farouc A. Jaffer



The purpose of this study was to demonstrate the feasibility of real-time fusion of coronary computed tomography angiography (CTA) centreline and arterial wall calcification with x-ray fluoroscopy during chronic total occlusion (CTO) percutaneous coronary intervention (PCI).


Patients undergoing CTO PCI were prospectively enrolled. Pre-procedural CT scans were integrated with conventional coronary fluoroscopy using prototype software. We enrolled 24 patients who underwent CTO PCI using the prototype CT fusion software, and 24 consecutive CTO PCI patients without CT guidance served as a control group.


Mean age was 66 ± 11 years, and 43/48 patients were men. Real-time CTA fusion during CTO PCI provided additional information regarding coronary arterial calcification and tortuosity that generated new insights into antegrade wiring, antegrade dissection/reentry, and retrograde wiring during CTO PCI. Overall CTO success rates and procedural outcomes remained similar between the two groups, despite a trend toward higher complexity in the fusion CTA group.


This study demonstrates that real-time automated co-registration of coronary CTA centreline and calcification onto live fluoroscopic images is feasible and provides new insights into CTO PCI, and in particular, antegrade dissection reentry-based CTO PCI.

Key Points

• Real-time semi-automated fusion of CTA/fluoroscopy is feasible during CTO PCI.

• CTA fusion data can be toggled on/off as desired during CTO PCI

• Real-time CT calcium and centreline overlay could benefit antegrade dissection/reentry-based CTO PCI.


Coronary angiography Multidetector computed tomography Percutaneous coronary intervention Atherosclerosis Automatic data processing 



Antegrade dissection/reentry


Coronary CT angiography


Computed tomography


Chronic total occlusion


Major adverse cardiac events


Multiplanar reformat


Percutaneous coronary intervention



The scientific guarantor of this publication is Farouc A. Jaffer. The authors of this manuscript declare relationships with the following companies:

Dr. Girard is an employee of Siemens Healthcare. Dr Brilakis received consulting honoraria/speaker fees from St Jude Medical, Terumo, Asahi, Abbott Vascular, Somahlution, Elsevier, and Boston Scientific and research grant from InfraRedx; Dr. Brilakis’s spouse is an employee of Medtronic. Dr. Lombardi has consulted for Boston Scientific, Abbott Vascular, and Asahi Intecc; Dr Lombardi’s spouse is an employee of Spectranetics. Dr. Yeh has consulted for Abbott Vascular and Boston Scientific. Dr. Ghoshhajra has consulted for Siemens Healthcare and Medtronic. Dr. Jaffer receives research funding from Siemens Medical Solutions, Kowa, Canon, and the National Institutes of Health, and has consulted for Boston Scientific and Abbott Vascular. All remaining authors have no relevant conflicts of interest.

This work was supported in part by a research grant from Siemens Medical Solutions. One of the authors has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: prospective, case-control study, performed at one institution.


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Copyright information

© European Society of Radiology 2016

Authors and Affiliations

  • Brian B. Ghoshhajra
    • 1
  • Richard A. P. Takx
    • 1
  • Luke L. Stone
    • 2
  • Erin E. Girard
    • 3
  • Emmanouil S. Brilakis
    • 4
  • William L. Lombardi
    • 5
  • Robert W. Yeh
    • 2
  • Farouc A. Jaffer
    • 2
  1. 1.Cardiac MR PET CT Program, Massachusetts General Hospital, Department of Radiology and Division of CardiologyHarvard Medical SchoolBostonUSA
  2. 2.Cardiac Cathetrization Laboratory, Cardiology Division, Massachusetts General HospitalHarvard Medical SchoolBostonUnited States
  3. 3.Siemens HealthcarePrincetonUSA
  4. 4.Cardiology Division, Dallas VA Medical Center and UT Southwestern Medical CenterDallasUSA
  5. 5.Cardiology DivisionUniversity of WashingtonSeattleUSA

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