CARAT Tutorials: Navigating CARAT

Step 1 - Select the Report Type:

Select the type of report desired (Angiographic, CTA, PCI, CABG or Cath-to-PCI) from

‘File’ > ‘Report Heading’.

Figure 1: Selecting a report type.

Step 2 – Basic Native Coronary Anatomy Templates:

Initiate CARAT diagram construction by selecting templates that define:

• coronary artery dominance
• primary arterial positioning within the interventricular groove
• secondary side-branching patterns on the LV free wall
• configuration of septal perforators
• SA node branch location
• nature of any anomalous vessel origins and pathways.

The template menus needed to accomplish this are shown under the tab headings on the top right of the working screen. The tab options are sequentially presented.

Figure 2: Template Tabs.

The first or Welcome tab gives the operator the option to Proceed Without Defaults (the preferred selection) allowing full customization of configuration possibilities, or View Default Options allowing for the rapid construction of a coronary configuration for teaching and demonstration purposes.

Figure 3: The CARAT Welcome Screen.

With each successive template selection, a new set of templates is presented, and the most appropriate of these is selected by a left mouse-click. As the selection process proceeds, a picture progressively emerges on the drawing area to the left. It is not necessary to follow the tab sequence as presented although most operators find that the order is useful.

The template options are organized by branch location and branch size (the location reflecting the LV segment point of origin of the branch and the size reflecting the approximate number of LV segments from the 17-segment model supplied by the branch in question). Hovering the mouse pointer over the template choices to the right opens a mouse-over box describing each option.

Options on a yellow background indicate options involving an anomalous origin or pathway of a segment or branch.

Once the basic anatomy is decided upon, options are available to specify tertiary side-branch and segment detail. These options can be seen by right-clicking on the segment that you wish to alter. (As shown in Figure 3, the operator is contemplating altering a posterolateral branch. There are a number of branching configurations and branch sizes to chose from for this branch as seen in the drop-down menu.)

Figure 4: Refining secondary and tertiary side-branch detail.

Branch editing will be discussed in more detail in a subsequent tutorial.

Step 3 – Begin Entering Arterial Detail:

When the native anatomy is decided upon, disease and intervention detail can be entered. This descriptive function is initiated by right-clicking the mouse on the drawing area (but not on the artery segments). A menu list is revealed (Figure 4), and an item is selected by left-clicking the desired item (in this example the ‘Lesion’ Edit Mode).

Figure 5: Disease and intervention detail menu.

The lesion (or other menu selection) is placed upon the diagram by clicking and holding the left mouse button as the disease element/stent is ‘drawn’ along the vessel. This must be done from proximal to distal.

In addition, caution must be taken to make sure that the mouse button is activated and released within the boundaries of the artery. When working in small spaces, the ‘Zoom’ function of your mouse (scroll) can be extremely useful.

The ‘CARAT Task Bar’ specifying the active menu Edit Mode is located along the lower perimeter of the window (Figure 6). The lower-left corner reminds you which ‘Edit Mode’ you are in, while the section to the right defines the functions of the left and right mouse buttons in the selected Edit Mode. Right-click on any open area on the diagram to exit the current ‘Edit Mode’.

Figure 6: The CARAT taskbar highlighted at bottom.

Step 4 – Secondary Edit Menus:

In most cases, secondary menus are available for each Edit Menu item to specify greater item detail. (The example given in Figure 7 is the ‘Lesion’ sub-menu).

Figure 7: Choosing greater item detail options.

In addition, tertiary submenus are available to specify Culprit lesions, Lesion Features, FFR measurements, and Area at Risk detail. These tertiary menus are opened by left-clicking the desired item and then right-clicking on the features for details that you wish to record.

Step 5 – Place Surgical Grafts:

Surgical graft placement is facilitated by selecting ‘Grafts’ on the main Edit Menu. When this selection is made, available graft targets (circles) are shown on the diagram.

Figure 8: Choosing the graft-type options.

The desired graft target is selected with a mouse ‘right-click’ after which the graft-type options are presented for selection by a mouse left-click. Further detail on graft selection is included in a separate tutorial.

Step 6 – Draw Stents:

After selecting “Stent” from the main Edit Menu, the stent is drawn, proximal to distal on a coronary segment, using the left mouse button (again ensuring that the mouse point stays within the stented segment).

Figure 9: The stent procedure detail menu.

After the stent is placed, a detailed accounting of the stenting procedure can be documented by right-clicking the STENT and selecting the Intervention Detail drop-down window.

Detail on Access, devices used and specific strategies then can be selected by ‘left-clicking’. Entries from this menu will be displayed as a ‘Stent Summary’ on the upper left corner of the report (Figure 10).

This topic is dealt with in more detail in a separate tutorial.

Figure 10: The stent procedure accounting summary.

Key Points:

• The active ‘Edit Mode’ is shown in the lower left-hand corner.

• Stay within vessel boundaries when entering disease elements.

Diagrams generated by the CARAT trial version can be saved and exported in pdf format.