Virtual Coronary Intervention A Treatment Planning Tool Based Upon the Angiogram

OBJECTIVES This study sought to assess the ability of a novel virtual coronary intervention (VCI) tool based on invasive angiography to predict the patient's physiological response to stenting. BACKGROUND Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) is associated with improved clinical and economic outcomes compared with angiographic guidance alone. Virtual (v) FFR can be calculated based upon a 3-dimensional (3D) reconstruction of the coronary anatomy from the angiogram, using computational fluid dynamics (CFD) modeling. This technology can be used to perform virtual stenting, with a predicted post-PCI FFR, and the prospect of optimized treatment planning. METHODS Patients undergoing elective PCI had pressure-wire-based FFR measurements pre- and post-PCI. A 3D reconstruction of the diseased artery was generated from the angiogram and imported into the VIRTUheart workflow, without the need for any invasive physiological measurements. VCI was performed using a radius correction tool replicating the dimensions of the stent deployed during PCI. Virtual FFR (vFFR) was calculated pre- and post-VCI, using CFD analysis. vFFR pre- and post-VCI were compared with measured (m) FFR pre- and post-PCI, respectively. RESULTS Fifty-four patients and 59 vessels underwent PCI. The mFFR and vFFR pre-PCI were 0.66 +/- 0.14 and 0.68 +/- 0.13, respectively. Pre-PCI vFFR deviated from mFFR by -0.05 (mean Delta = -0.02; SD = 0.07). The mean mFFR and vFFR post-PCI/VCI were 0.90 +/- 0.05 and 0.92 +/- 0.05, respectively. Post-VCI vFFR deviated from post-PCI mFFR by -0.02 (mean Delta = -0.01; SD = 0.03). Mean CFD processing time was 95 s per case. CONCLUSIONS The authors have developed a novel VCI tool, based upon the angiogram, that predicts the physiological response to stenting with a high degree of accuracy. (C) 2019 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.