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RCA stent and LAD occlusion

Case Study
CT Marketing Philips Healthcare

Clinical history

This 56 year-old male has a history of an acute inferior myocardial infarction, which was treated with a primary stent placed in the right coronary artery (RCA). His cardiac cath showed the culprit lesion in RCA plus a prior silent total occlusion of the left anterior descending artery (LAD) just after the 1st diagonal (D1). To follow the patient, a CT scan was ordered.

Image scan parameters

  • 40 x 0.625 mm
  • 0.4 second
  • 120 kV
  • 601 mAs/slice
  • 0.9 mm thickness
  • 0.6 mm increment
  • 10 secomd scan time
  • 140 mm scan length
  • 6 cc/sec for a total of 100cc's followed by 50cc's saline
 Slab reverse Volume Intensity Projection (VIP) of the heart and left coronary arteries. The LM and diagonal branch are well visualized. Note the LAD occlusion and vessel enhancement. Slab VIP image of the RCA shows the location of the stent within the vessel. 2D Map of the coronary arteries. There is a stent in the RCA plus LAD occlusion.
Slab reverse Volume Intensity Projection (VIP) of the heart and left coronary arteries. The LM and diagonal branch are well visualized. Note the LAD occlusion and vessel enhancement.
Slab VIP image of the RCA shows the location of the stent within the vessel.
2D Map of the coronary arteries. There is a stent in the RCA plus LAD occlusion.
 Invasive coronary angiography shows occlusion after the 1st diagonal branch. Note distal LAD not visualized. Volume rendered image demonstrates the LAD occlusion
and RCA.
Invasive coronary angiography shows occlusion after the 1st diagonal branch. Note distal LAD not visualized.
Volume rendered image demonstrates the LAD occlusion and RCA.

Diagnosis

The coronary CTA (CCTA) demonstrates a patent stent in the RCA and the distal LAD filled by collateral flow. The CCTA information visualizing the distal LAD obtained is better than what was seen during cardiac cath. In addition, the "skip" distance of the LAD occlusion is captured as well.

Clinical Significance

An intraluminal coronary artery stent is a small, self-expanding, stainless steel mesh tube that is placed within a coronary artery to keep the vessel open. It may be used, after balloon angioplasty to prevent reclosure of the blood vessel. In this case, the patient had the stent placed during treatment of acute myocardial infarction.

 

The CCTA results were useful in evaluating the location, length and anatomy of total LAD occlusion for consideration of intervention. The scan additionally demonstrates the RCA stent location and patency.

 

Coronary CTA (CCTA) is a "new" standard of care that can be used to follow or evaluate patients for coronary artery disease. It is a brilliant strategy based on its fast, non-invasive technique and the quality of information obtained. This procedure can define the course of treatment, which may require surgical or medical intervention.

 

The Philips Brilliance CT 40-channel system with its cardiac specific applications provides the tools to enhance departmental workflow. The scanner's patented Rate Responsive image acquisition technology adapts to the patient - rather than the other way around, providing up to 53 ms temporal resolution.



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Feb 10, 2006

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Case Study
Brilliance 40-channel
Cardiac, chest CTA, coronary angiography, coronary arteries, LAD, Myocardial infarction, occlusion, Rate Responsive, RCA, retrospective, stent, Vascular, VIP
 

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