Rotational angiography and 3 D coronary modeling : revolutions in the cardiac cath lab

the coronary arterial tree, derived from analysis of two-dimensional angiographic data. The goal of each angiographic image is to view as much of the coronary tree as possible, while at the same time minimizing vessel overlap and foreshortening of vessel segments in areas of interest. Due to marked individual variation, however, many views provide little or none of the visual information needed for diagnosis and therapy. If the operator is not satisfied with the angiographic data obtained at first, he or she may then 'optimize' the images by taking more angiograms from different angles, based on his or her individualized mental impression of the coronary arterial tree. The quality and content of the angiographic images is, therefore, dependent on the visual skills and experience of the angiographer. Furthermore, angiograms obtained in this fashion are not standardized. When angiograms are shared among referring physicians or transferred between medical centers, the information contained within the selected images only reflects what the original angiographer saw or was satisfied in seeing. These images are crucial for treatment decisions and may lead a patient down the path to surgery, percutaneous revascularization, or medical therapy. When it comes to the planning and execution of percutaneous coronary interventions, a more sophisticated understanding of the three-dimensional coronary tree is required. The visual skills of the operator working in the world of two-dimensional images become a critical determinant of procedure outcome. Cardiologists, who are now under tremendous time constraints in a field of ever-increasing complexity, need advances in angio-graphic imaging technology that remove some of their day-today burden, and improve safety for their patients. The development of rotational angiography and three-dimensional (3D) coronary modeling are two such advancements which are poised to significantly improve the safety and efficacy of coronary angiography/interventions, and pave the way for future applications in non-cardiac angio-graphic imaging and imaging systems integration. Percutaneous coronary interventions have grown over the past two decades to become the most widely employed revascularization method for the treatment of coronary artery disease. With the advent of drug-eluting stents and other new devices, the frequency of percutaneous revascularization procedures is expected to double in the coming years. Driven by advances in technology, interventional procedures are also becoming increasingly more complex. Today we can successfully treat very ill patients with two or three complex coronary blockages during a single procedure. But the demands on interventional cardiologists today are immense. The large volume …