Status:Not yet recruiting
Keywords:CTO , chronic , total , occluded , 3D images
Sub Specialty:Interventional Cardiology
The objectives of the study include:
-To use the DynaCT and 3D Cardiac Vascular Reconstruction with Motion Compensation software during cardiovascular intervention procedures.
-To provide the safest and most technologically advanced cardiovascular intervention for patients.
Currently, cardiovascular interventional procedures are performed using real-time fluoroscopy systems which generate two-dimensional (2D) projection images of the heart. This is used not only to visualize the heart structures, often by injecting a radio-opaque contrast agent, but also to visualize and navigate interventional devices, such as catheters and guide wires, as they are used to perform the interventional procedure. One of the challenges of these procedures is to visualize and navigate in three-dimensional (3D) space using 2D projection images of the heart. While it is possible to capture 2D images of the heart from various projection angles, creation of a true 3D image of the heart structures during procedure is also now possible. In the past, 3D-imaging was mainly performed with diagnostic imaging systems, such as CT and MR, whereas angiographic C-arm systems have been suitable only for projection imaging. More recently, 3D-imaging of high contrast objects e.g. vascular structures filled with contrast medium has become a part of the imaging functionalities of C-arm systems and is now widely used in the clinical routine. C-arm Computed Tomography (CBCT), or C-arm CT, is a technology that utilizes an X-ray tube and flat panel detector system, to acquire and allow construction of three dimensional images of both vascular and soft tissue structures . This is accomplished by rotating the C-arm around the patient while collecting an array of equally spaced 2D X-ray projection images, and then using algorithms to reconstruct a three-dimensional image. While this technique was at first limited to imaging high-contrast structures such as bone and contrast-filled vessels, the availability of flat panel detectors has enabled the ability to obtain CT like images of soft tissue. C-arm CT for anatomical imaging is a released, FDA cleared product, manufactured by Siemens Medical Solutions, with the product name syngo DynaCT. It is currently used in applications such as endovascular treatment of aneurysms and vascular occlusions [2,3], liver tumor embolization and transjugular intrahepatic portosystemic shunt (TIPS) placement. This technology has recently been adapted for imaging dynamic structures such as the beating heart  and is a released, FDA cleared product manufactured by Siemens Medical Solutions, with the product name syngo DynaCT cardiac. This adaptation consists of making multiple sweeps (as opposed to the single sweep used for imaging static structures), while recording the ECG, such that a single arc of image data can be collected for one phase of the cardiac cycle, via retrospective gating, and a 3D image for that phase then reconstructed. This new technology has been successful at imaging heart structures including the four hear chambers, pulmonary outflow track. Due to temporal resolution, finer structures of the heart have been challenging for imaging, i.e., coronary arteries, coronary sinus vein, etc. Cardiac motion can be challenging for 3D imaging. For conventional CT, the speed of acquisition is critical for collection of the data in a period of time of less then 100ms. Cardiac motion is basically frozen. Angiographic c-arm systems need 5s for a complete data acquisition, which means a bigger challenge for reconstructing small structures like coronary arteries, vessels, or stent-like devices. Recent techniques ,  allow estimating the heart motion from the set of projection data. Knowing the motion it can be compensated during 3D image reconstruction. Preliminary studies suggest that the method is feasible in reconstruction of the morphology of such sparse, high contrast objects. A clinical application in 3D imaging of the Coronary Sinus for implantation of biventricular pacemaker is presented in .