Determination of Optimal Fluoroscopic Angulations for Left Main Coronary Artery Ostial Interventions: 3-Dimensional Computed Tomography Validation

Figure 7

(a) Two 0.035-inch wires were advanced to the NCC and RCC using the anterior-posterior view; (b) the lowest points in the curve at the distal part of these two wires were superimposed at LAO18/CRA16; (c) LMCA angiography was performed at the angulation; (d) the stent was located at the angulation; (e) the image of LMCA after stent deployed; (f) LMCA ostial lesion was showed by intravascular ultrasound (OptiCrossTM HD; Boston Scientific) that was withdrawn at a pullback speed of one millimeter equal to 60 frames before stenting; (g, h) in the poststenting pullback, the LMCA ostium was at frame 1708 and the stent ostium was at frame 1814. So the stent protruded to the aorta for 1.77 mm ((1814–1708)/60); (i) the NCC and RCC overlapped at LAO12/CRA18 by FluoroCT; (j) the LMCA ostium faced to the NCC-RCC commissure in this patient (bottom left corner); (k) blue line was aortic valve plane and orange line was LMCA plane; (l) the two S-curves consisting of an unlimited number of pairs of C-arm angulations which were tangential to the aortic annulus and LMCA ostium crossed at LAO12/CRA21. CAU = caudal; CRA = cranial; LAO = left anterior oblique; RAO = right anterior oblique.