Automated 3D analysis of pre-implantation MDCT accurately predicts the LP of the aortic annulus and the corresponding C-arm position required for TAVR. With this approach, the implantation of the balloon-expandable prosthetic valve can be performed without an aortogram in the majority of cases and still be safe, with a low rate of valve malpositioning and regurgitation.

The aim of our study has been to evaluate the ability of 64-slice computed tomographic angiography (CTA) to assess coronary artery stent patency, relative to selective coronary angiography (SCA). Fifty-five consecutive patients (age range 45-80 years) with 97 previously implanted coronary artery stents underwent 64-slice CTA. The 55 patients comprised 40 subjects (group A) who were referred for follow-up SCA at a mean interval of 9.6 months after stent positioning, and 15 subjects (group B) in whom SCA was clinically indicated. Stent evaluation was performed independently by two blinded readers in terms of image quality and presence of in-stent restenosis (ISR; lumen obstruction of >or=50%). SCA was performed in 41/55 patients; 14 patients refused to undergo SCA after the 64-slice CTA exam. A total of 88 stents in 74 segments were analyzed. Twenty-one of the 74 stented segments were of poor image quality and were not considered for further analysis. Sixty-four-slice CTA detected 12/16 ISR (sensitivity: 75%) and ruled out ISR in 32/37 cases (specificity: 86%). Sixty-four-slice CTA is a valuable modality for follow-up of coronary artery stent patency only in selected patients. Appropriate candidates for follow-up 64-slice CTA should be established based on stent diameter, stent material and type as well as HR and heart rhythm. However, given the number of non-assessable segments, further work would appear necessary before 64-slice CTA can be considered a suitable procedure for broad clinical application in the evaluation of coronary artery stent patency.

Coronary lesions were reliably evaluated by 64-slice CTA in the follow-up of compliant patients with KD, reducing the need for repeated diagnostic invasive CCA. Hence, in an adequately selected patient population, the role of CCA could be limited almost only to therapeutic procedures.

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