Stent sizing by coronary CT angiography compared with optical coherence tomography

• DOI: 10.1016/j.jcct.2024.03.002
• Publication Date: 2024-05-23T19:58:24Z
• Authors: Brian Ko; Hirofumi Ohashi; Takuya Mizukami; Koshiro Sakai; Jeroen Sonck; Bjarne Linde Nørg...; Michael Maeng; Jesper Møller Jensen; Abdul Ihdayhid; Atomu Tajima; Hirohiko Ando; Tetsuya Amano; Bernard De Bruyne; Bon-Kwon Koo; Hiromasa Otake; Carlos Collet
• Keywords: 03 medical and health sciences; 0302 clinical medicine; Optical coherence tomography; Coronary computed tomography angiography; Percutaneous coronary intervention

Coronary CT angiography (CCTA) is well-established for diagnosis and stratification of coronary artery disease (CAD). Its usefulness in guiding percutaneous coronary interventions (PCI) and stent sizing is unknown.This is a sub-analysis of the Precise Percutaneous Coronary Intervention Plan (P3) study (NCT03782688). We analyzed 65 vessels with matched CCTA and pre-PCI optical coherence tomography (OCT) assessment. The CCTA-guided stent size was defined by the mean distal reference lumen diameter rounded up to the nearest stent diameter. The OCT lumen-guided stent size was the mean distal reference lumen diameter rounded to the closest stent diameter. The agreement on stent diameters was determined with Kappa statistics, Passing-Bablok regression analysis, and the Bland-Altman method.The distal reference lumen diameter by CCTA and OCT were 2.75 ​± ​0.53 ​mm and 2.72 ​± ​0.55 ​mm (mean difference 0.06, limits of agreement -0.7 to 0.82). There were no proportional or systematic differences (coefficient A 1.06, 95% CI 0.84 to 1.3 and coefficient B -0.22, 95% CI -0.83 to 0.36) between methods. The agreement between the CCTA and OCT stent size was substantial (Cohen's weighted Kappa 0.74, 95% CI 0.64 to 0.85). Compared to OCT stent diameter, CCTA stent size was concordant in 52.3% of the cases; CCTA overestimated stent size in 20.0% and underestimated in 27.7%.CCTA accurately assessed the reference vessel diameter used for stent sizing. CCTA-based stent sizing showed a substantial agreement with OCT. CCTA allows for PCI planning and may aid in selecting stent diameter.