良永 真隆

AIMS: In percutaneous coronary intervention (PCI), a suboptimal choice of guiding catheter may compromise coaxial alignment and backup support, prolonging procedures and increasing radiation and contrast exposure. We assessed whether a computed tomography (CT)-driven, artificial intelligence (AI)-guided preprocedural simulation could improve procedural efficiency and safety. METHODS AND RESULTS: In a single-centre prospective registry with historical controls, 55 consecutive elective procedures performed with CT-based AI-assisted guiding-catheter selection were compared with 55 procedures performed without assistance. The primary endpoint was total procedure time from arterial access to completion. Secondary endpoints included time to coronary engagement, radiation dose, contrast volume, and guiding-catheter-related events. Computed tomography--based AI assistance was associated with shorter procedures (mean 68.5 vs. 91.8 min), shorter engagement time, lower radiation dose, and lower contrast use. Guiding-catheter exchanges were fewer, and catheter-related events were lower (3.6 vs. 16.4%; risk ratio 0.22; 95% confidence interval 0.05-0.98). Procedural success was 100% in both groups with no in-hospital major adverse cardiac or cerebrovascular events. CONCLUSION: A CT-driven, CT-based AI-guided simulation for guiding-catheter selection was associated with greater procedural efficiency and a favourable profile in elective PCI. This approach, which standardizes catheter choice and is associated with fewer empirical catheter exchanges, warrants confirmation in multicentre randomized studies and may help optimize resource utilization in routine PCI.

We present a novel, simple, and low-cost "side-hole" technique for a patient with ST-segment elevation myocardial infarction (STEMI) caused by an occlusion of an anomalous origin of the culprit coronary artery (AOCCA). In a case where standard guiding catheters failed to engage the anomalous left coronary artery (LCA), we created an approximately 3 mm side-hole near the tip of a 5 Fr diagnostic catheter and then introduced a guidewire and microcatheter directly into the anomalous left main trunk (LMT). Subsequently, we withdrew this diagnostic catheter and exchanged it for a guiding catheter over the guide wire, enabling rapid primary PCI. This approach facilitated rapid wire passage, minimized additional device use, and helped reduce overall reperfusion time. It may be especially useful in urgent STEMI cases where a suitable guiding catheter for AOCCA lesions cannot be readily identified.