Computed Tomography in Total coronary Occlusions (CTTO Registry): radiation exposure and predictors of successful percutaneous intervention

被引:79
作者
Garcia-Garcia, Hector M.
van Mieghem, Carlos A. G.
Gonzalo, Nieves
Meijboom, Willem B.
Weustink, Annick C.
Onuma, Yoshinobu
Mallet, Nico R.
Schultz, Carl Johann
Meliga, Emanuele
van der Ent, Martin
Sianos, Giorgios
Goedhart, Dick [2 ]
den Boer, Ad
de Feyter, Pim
Serruys, Patrick W. [1 ]
机构
[1] Erasmus MC, Dept Cardiol, Thoraxctr, Erasmus Med Ctr, NL-3015 CE Rotterdam, Netherlands
[2] Cardialysis BV, Rotterdam, Netherlands
关键词
Chronic total occlusion; computed tomography coronary angiography; radiation exposure; RECANALIZATION; ANGIOGRAPHY; ANGIOPLASTY; EXPERIENCE; ARTERIES;
D O I
10.4244/EIJV4I5A102
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aims: There is no mention in the current "appropriateness criteria for CTCA" of the need of CTCA investigation prior to an attempt at recanalisation of a CTO. To define better the role of CTCA in the treatment of patients with CTOs, we performed CTCA in a consecutive cohort of eligible patients who were scheduled for percutaneous recanalisation of a CTO. Methods and results: Symptomatic patients due to a CTO suitable for percutaneous treatment were included. One hundred and thirty-nine (142 CTOs) patients were studied. Overall success rate was 62.7%. By CTCA, the occlusion length was 24.9 +/- 18.3 vs. 30.7 +/- 20.7mm in successful and failed cases (p=0.1), but the frequency of patients with an occlusion length >15 mm was different, i.e. 63.2% vs. 82.7%, respectively (p=0.02). Severe calcification, (> 50% CSA) was more prevalent in failed cases (54.7% vs. 35.9%, p=0.03). Calcification at the entry of the occlusion was present in 58.5% of the failures vs. 41.6% of the successful cases (p=0.04), while calcium at the exit was not different. The length of calcification was 8.5 +/- 8.4 vs. 5.5 +/- 6.6 mm in the failed and successful cases respectively (p=0.027). By multivariable analysis, the only independent predictor of procedural success was the absence of severe calcification as defined by CTCA. The mean effective radiation dose of the PCI was 39.3 +/- 30.1 mSv. The mean effective radiation dose of CT scan was 22.4 mSv: 19.2 +/- 6.5 mSv for contrast-enhanced scan, 3.2 +/- 1.7 mSv for calcium scoring scan. Conclusions: More severe calcified patterns, as assessed by CTCA, are seen in failed cases. The radiation exposure during a CT scan prior to a CTO PCI is considerable, and further studies are required to determine whether this extra diagnostic study is warranted.
引用
收藏
页码:607 / 616
页数:10
相关论文
共 22 条
[1]   Recent trends in the percutaneous treatment of chronic total coronary occlusions [J].
Abbott, JD ;
Kip, KE ;
Vlachos, HA ;
Sawhney, N ;
Srinivas, VS ;
Jacobs, AK ;
Holmes, DR ;
Williams, DO .
AMERICAN JOURNAL OF CARDIOLOGY, 2006, 97 (12) :1691-1696
[2]   Computed tomography coronary angiography [J].
Achenbach, Stephan .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2006, 48 (10) :1919-1928
[3]   PREDICTION OF CREATININE CLEARANCE FROM SERUM CREATININE [J].
COCKCROFT, DW ;
GAULT, MH .
NEPHRON, 1976, 16 (01) :31-41
[4]   Real-time quantification and display of skin radiation during coronary angiography and intervention [J].
den Boer, A ;
de Feijter, PJ ;
Serruys, PW ;
Roelandt, JRTC .
CIRCULATION, 2001, 104 (15) :1779-1784
[5]  
Di Mario Carlo, 2007, EuroIntervention, V3, P30
[6]  
Garcia-Garcia Hector M, 2007, EuroIntervention, V3, P188, DOI 10.4244/EIJV3I2A34
[7]   Percutaneous coronary intervention for chronic total occlusions: the Thoraxcenter experience 1992-2002 [J].
Hoye, A ;
van Domburg, RT ;
Sonnenschein, K ;
Serruys, PW .
EUROPEAN HEART JOURNAL, 2005, 26 (24) :2630-2636
[8]   Significant reduction in restenosis after the use of sirolimus-eluting stents in the treatment of chronic total occlusions [J].
Hoye, A ;
Tanabe, K ;
Lemos, PA ;
Aoki, J ;
Saia, F ;
Arampatzis, C ;
Degertekin, M ;
Hofma, SH ;
Sianos, G ;
McFadden, E ;
van der Giessen, WJ ;
Smits, PC ;
de Feyter, PJ ;
van Domburg, RT ;
Serruys, PW .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2004, 43 (11) :1954-1958
[9]  
Husmann L, 2008, EUR HEART J, V29, P191, DOI 10.1093/eurheartj/ehm613
[10]  
KRONMAL RA, 2001, J AM COLL CARDIOL, V37, P451