Browsing by Author "Knaapen, Paul"
Now showing 1 - 3 of 3
Results Per Page
Sort Options
Publication CCTA-Guided Selective Invasive Coronary Catheterization: A Strategy to Reduce Contrast Volume and Improve Efficiency(2025) Dahdal, Jorge; Jukema, Ruurt; Somsen, Aernout; Kooijman, Eline; Wahedi, Ellaha; Lemkes, Jorrit; Raijmakers, Pieter; Heestermans, Ton; Van Royen, Niels; Knaapen, Paul; Danad, IbrahimBackground: Symptomatic patients with unilateral obstructive coronary artery disease (CAD) identified by coronary computed tomography angiography (CCTA), involving either the right or left coronary artery, typically undergo per-protocol bilateral coronary visualization during invasive coronary angiography (ICA). However, a selective visualization approach may be sufficient. Objectives: The objectives of this study were to assess the accuracy of CCTA in excluding hemodynamically significant coronary stenosis in patients with unilateral CAD and to evaluate whether a CCTA-guided selective ICA strategy can reduce procedure time and contrast agent use. Methods: In this cross-sectional cohort study, 454 patients with clinically suspected stable CAD who underwent CCTA prior to ICA were included. The study population consisted of 190 patients with unilateral obstructive CAD, defined as ≥50% diameter stenosis on CCTA, and an absence of obstructive CAD on the contralateral side. ICA with invasive functional assessment was used as the reference standard. Results: CCTA demonstrated a high accuracy, 97.4% (95% CI: 94-99%), in excluding hemodynamically significant disease in the contralateral arteries without obstructive CAD. Compared to the conventional ICA approach, a CCTA-guided selective visualization strategy resulted in significant reductions in procedure time and contrast agent usage: procedure time and contrast agent usage were reduced by 27% (95% CI: 12.1-47.5%) and 46.8% (95% CI: 27.5-67.0%), respectively. Conclusions: In patients with unilateral obstructive CAD identified by CCTA, a CCTA-guided selective ICA visualization strategy is highly accurate in ruling out hemodynamically significant CAD on the contralateral side. Additionally, this unilateral ICA approach has the potential to reduce both contrast agent usage and procedure time compared to the conventional bilateral visualization strategy.Publication Diagnostic performance of CCTA and CTP imaging for clinically suspected in-stent restenosis: A meta-analysis(2024) Dahdal, Jorge; Jukema, Ruurt A.; Remmelzwaal, Sharon; Raijmakers, Pieter G.; Harst, Pim van der; Guglielmo, Marco; Cramer, Maarten J.; Chamuleau, Steven A.J.; Diemen, Pepijn A. van; Knaapen, Paul; Danad, IbrahimAims: The objective of this study is to conduct a meta-analysis to assess the diagnostic performance of Coronary Computed Tomography Angiography (CCTA) and a hybrid approach that incorporates Computed Tomography Perfusion (CTP) in addition to CCTA (CCTA þ CTP) for the detection of in-stent restenosis (ISR), as defined by angiography. Methods: A comprehensive search of articles identified 18,513 studies. After removing duplicates, title/abstract screening, and full-text review, 17 CCTA and 3 CCTA þ CTP studies were included. Only studies using 64-slices multidetector computed tomography (CT) were considered eligible. Results: The per-patient ISR prevalence was 43 %, with 92 % of stents fully interpretable with CCTA. Meta-analysis exhibited a per-stent CCTA (n ¼ 2674) sensitivity of 90 % (95 % CI; 84–94 %), specificity of 89 % (95 % CI; 86–92 %), positive likelihood ratio of 7.17 (95 % CI; 5.24–9.61), negative likelihood ratio of 0.17 (95 % CI; 0.10–0.25), and diagnostic odds ratio of 45.7 (95 % CI; 22.71–82.43). Additional sensitivity analyses revealed no influence of stent diameter or strut thickness on the diagnostic yield of CCTA. The per-stent diagnostic performance of CCTA þ CTP (n ¼ 752) did not show differences compared to CCTA. Conclusions: With currently utilized scanners, CCTA and CCTA þ CTP demonstrated high diagnostic performance for in-stent restenosis evaluation. Consequently, a history of previous stent implantation should not be an argument to preclude using these methods in clinically suspected patients.Publication Myocardial perfusion imaging in advanced coronary artery disease(2025) Hoek, Roel; Van Diemen, Pepijn; Somsen, Yvemarie; De Winter, Ruben W.; Jukema, Ruurt; Dahdal, Jorge; Raijmakers, Pieter; Driessen, Roel; Danad, Ibrahim; Knaapen, PaulMyocardial perfusion imaging (MPI) is widely adapted as a noninvasive technique to assess the presence and extent of ischemia in patients with symptoms suggestive of obstructive coronary artery disease (CAD). However, as CAD advances, several factors can complicate the interpretation of MPI, subsequently impacting clinical decision-making. This review focuses on the utility of MPI by means of cardiac magnetic resonance (CMR) imaging, single-photon emission computed tomography (SPECT) and positron emission tomography (PET) in patients with advanced CAD-the latter characterized by documented CAD (i.e. prior myocardial infarction [MI] and/or percutaneous coronary intervention [PCI]), prior coronary artery bypass grafting (CABG) or the presence of a chronic total occlusion (CTO). It will discuss factors impacting the interpretation of MPI, the diagnostic performance for detecting obstructive CAD and coronary microvascular dysfunction (CMD), as well as the role of MPI in guiding revascularization.