Cardiac CT angiography after percutaneous left atrial appendage closure: early versus delayed scanning after contrast administration

Gilhofer, Thomas; Abdellatif, Waleed; Nicolaou, Savvas; Jalal, Sabeena; Powell, Jennifer; Inohara, Taku; Starovoytov, Andrew; Saw, Jacqueline

doi:10.5152/dir.2021.20349

Cited by 4 publications

(3 citation statements)

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“…3DR, VR, and MIP techniques were employed to obtain multi‐directional anatomical information about the LAA and facilitate the selection of an appropriate occluder size. Our results demonstrated a high degree of consistency between the LAA morphology obtained from MIP and fluoroscopic imaging (Figure 4), underscoring the valuable guidance provided by CTA in LAAO, 8,18,19 particularly in the context of MLAAO.…”

Section: Discussionsupporting

confidence: 64%

A preliminary study of minimal left atrial appendage occlusion using Watchman under the guidance of fluoroscopy

Ruan,

Li,

Jin

et al. 2023

Cathet Cardio Intervent

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BackgroundLeft atrial appendage occlusion (LAAO) has been considered an alternative treatment to prevent embolic stroke in patients with nonvalvular atrial fibrillation (NVAF). However, it carries a risk of general anesthesia or esophageal injury if guided by transesophageal echocardiography (TEE).AimsWe aimed to investigate the feasibility and safety of minimal LAAO (MLAAO) using Watchman under fluoroscopy guidance alone in patients with NVAF.MethodsA total of 249 consecutive patients with NVAF who underwent LAAO using the WATCHMAN device were divided into two groups: the Standard LAAO (SLAAO) group and the MLAAO group. Procedural characteristics and follow‐up results were compared between the two groups.ResultsThere was no statistically significant difference in the rate of successful device implantation (p > 0.05). Fluoroscopy time, radiation exposure dose, and contrast medium usage in the MLAAO group were higher than those in the SLAAO group (p < 0.001). The procedure time and hospitalization duration were significantly lower in the MLAAO group than those in the SLAAO group (p < 0.001). The occluder compression ratio, measured with fluoroscopy, was lower than that measured with TEE (17.63 ± 3.75% vs. 21.69 ± 4.26%, p < 0.001). Significant differences were observed between the SLAAO group and the MLAAO group (p < 0.05) in terms of oropharyngeal/esophageal injury, hypotension, and dysphagia. At 3 months after LAAO, the MLAAO group had a higher incidence of residual flow within 1−5 mm compared to the SLAAO group, although the difference was not statistically significant.ConclusionMLAAO guided by fluoroscopy, instead of TEE, without general anesthesia simplifies the operational process and may be considered safe, effective, and feasible, especially for individuals who are unable to tolerate or unwilling to undergo TEE or general anesthesia.

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Section: Discussionsupporting

confidence: 64%

A preliminary study of minimal left atrial appendage occlusion using Watchman under the guidance of fluoroscopy

Ruan,

Li,

Jin

et al. 2023

Cathet Cardio Intervent

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“…Moreover, the operator can perform adequate preoperative assessment of the LAA, reasonably plan the landing zone, and estimate the occluder type, size, and axial direction after implantation using those techniques. Previous studies have shown that CCTA is more accurate than TEE in planning landing zone (10)(11)(12)(13). Numerous studies and expert consensus define the LAA landing zone under CCTA as the line connecting 1-2 cm inside Coumadin ridge to the left superior PV and the left circumflex coronary artery, and its depth as the distance from the midpoint of the landing zone diameter to the distal tip of the LAA (14)(15)(16).…”

Section: Discussionmentioning

confidence: 99%

The effect of two different methods of planning landing zone for left atrial appendage closure by cardiac computed tomography angiography: a comparative study

Li¹,

Zhang²,

Ruan³

et al. 2023

Ann Transl Med

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Background To explore the value of 2 different methods for planning landing zone for left atrial appendage closure (LAAC) by cardiac computed tomography angiography (CCTA). Methods A retrospective analysis was performed on the clinical data of patients who successfully underwent LAAC with the Watchman device at The Affiliated Taizhou People’s Hospital of Nanjing Medical University from August 2020 to February 2022. Two different methods were used to plan the landing zone and measure the longest diameter, average diameter, depth, and perimeter of the landing zone. The difference between the 2 methods and the correlation between their measurements and occluder size were analyzed. Results A total of 66 patients undergoing LAAC were included, with an average age of 69.35±7.1 years, of whom 30 (45.5%) were women. The mean error between the longest diameter measured by the traditional method and the actual value was 2.90±2.83 mm, and the mean absolute error (MAE) was 2.71 (1.17, 4.38) mm. The mean error between the longest diameter measured by the new method and the actual value was 0.9 (−0.13, 2.50) mm, and its MAE was 1.4 (0.40, 2.53) mm. The error of the longest diameter measured by the traditional method was larger than that measured by the new method (P<0.001). The mean error between the depth measured by the traditional method and the actual value was 1.40±3.45 mm, and the MAE was 2.36 (0.74, 4.58) mm. The mean error between the depth measured by the new method and the actual value was 0.10 (−1.33, 1.95) mm, and the MAE was 1.55 (0.60, 3.10) mm. Likewise, the depth error measured by the traditional method was larger than that measured by the new method (P<0.05). The correlation between the perimeter and the size of the occluder was the strongest (r=0.919, P<0.001). Conclusions With CCTA, the new method is more accurate in planning landing zone than the traditional method. It is particularly important to select the occluder size for the patients with flat oval landing zone ostium.

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“…Gerhoff et al [ 25 ] showed that the distribution of absolute HU values in LAA and the ratio of HU in LAA and LA differed significantly depending on the scanning phase. Therefore, using the absolute HU value in the proximal region of the LAA as the best and easiest method to detect PDL may not work with different scanners and scanning protocols.…”

Section: Discussionmentioning

confidence: 99%

Comparison of different quantitative evaluation protocols for peri-device leak detection using cardiac computed tomography angiography after left atrial appendage closure

Dong

Luo

et al. 2022

Int J Cardiovasc Imaging

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This study seeks to propose and compare different quantitative evaluation methods for identifying patients with peri-device leak (PDL) using cardiac computed tomography angiography (CCTA). Patients who had undergone left atrial appendage (LAA) closure and both transesophageal echocardiography (TEE) and CCTA were enrolled. Hounsfield units (HU) were measured in the proximal and distal regions of the left atrial appendage (p-LAA, d-LAA) on the CCTA, and the average of the two was determined (a-LAA). The relative HU ratios of the LAA to the center of the left atrium (LA) were calculated (p-LAA/c-LA, d-LAA/c-LA, a-LAA/c-LA). The area under the curve (AUC) for the LAA HU and the LAA/LA HU ratio were analyzed and compared. Fifty-one patients were included in this study. Pairwise comparisons showed a statistically significant difference (p = 0.029) in diagnostic performance between the d-LAA (AUC = 0.868) and a-LAA (AUC = 0.972). There were no significant differences between the a-LAA and p-LAA (p = 0.549) or between the d-LAA and p-LAA (p = 0.053). At the optimal cutoff for a-LAA of 115.5 HU, the sensitivity was 100%, the specificity was 88%. At the optimal cutoff for p-LAA of 109 HU, the sensitivity was 100%, the specificity was 84%. The LAA/LA HU ratio did not exhibit better diagnostic performance than HU attenuation in the LAA (p > 0.05). The a-LAA > 115.5 is useful in identifying PDL. Due to its convenience and intuitiveness, p-LAA > 109.0 can also be used as an alternative protocol for a-LAA.

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Cardiac CT angiography after percutaneous left atrial appendage closure: early versus delayed scanning after contrast administration

Cited by 4 publications

References 0 publications

A preliminary study of minimal left atrial appendage occlusion using Watchman under the guidance of fluoroscopy

A preliminary study of minimal left atrial appendage occlusion using Watchman under the guidance of fluoroscopy

The effect of two different methods of planning landing zone for left atrial appendage closure by cardiac computed tomography angiography: a comparative study

Comparison of different quantitative evaluation protocols for peri-device leak detection using cardiac computed tomography angiography after left atrial appendage closure

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