Coronary aorto-ostial stenosis analysed by multislice computed tomography: a new tool for percutaneous coronary intervention?

Aims: Conventional quantitative coronary angiography approaches are limited to quantify complex aorto-ostial stenosis. Multislice CT was able to detect and classify coronary plaques, compared with intravascular ultrasound (IVUS). The aim of the present study was to determine the accuracy of multislice computed tomography (CT) in addition to conventional angiography to identify aorto-ostial coronary stenosis characteristics before revascularisation. Methods and results: Patients with coronary ostial stenosis were selected for the study. All patients had selective coronary angiography and retrospectively ECG-gated multislice CT (Siemens AG, Munich, Germany). IVUS was performed in patients with ambiguous ostial stenosis revealed by angiography. Forty significant aorto-ostial lesions (38 patients) were analysed by two independent observers in comparison with an expert consensus blinded or not to the coronary CT data sets. Using CT in addition to angiography permitted observers to obtain a strong agreement for assessment of calcified lesions (kappa value 0.75), a good agreement for aortic plaques location and ideal stent position in aorto-ostial coronary stenosis. Conclusions: This study shows that CT associated with an angiogram allows a better identification of aorto-ostial plaques morphology and ideal stent position in aorto-ostial coronary stenosis before angioplasty.