Computed tomography angiography-guided percutaneous coronary intervention in chronic total occlusion

被引:18
作者
Li, Ping [1 ]
Gai, Lu-yue [1 ]
Yang, Xia [1 ]
Sun, Zhi-jun [1 ]
Jin, Qin-hua [1 ]
机构
[1] Chinese Peoples Liberat Army Gen Hosp, Dept Cardiol, Beijing 100853, Peoples R China
来源
JOURNAL OF ZHEJIANG UNIVERSITY-SCIENCE B | 2010年 / 11卷 / 08期
关键词
Dual-source computed tomography (DSCT); Chronic total occlusion (CTO); Angiography; Recanalization; ANGIOPLASTY; REVASCULARIZATION; EXPERIENCE;
D O I
10.1631/jzus.B1001013
中图分类号
Q5 [生物化学]; Q7 [分子生物学];
学科分类号
071010 ; 081704 ;
摘要
The aim of this study is to investigate if dual-source computed tomography (DSCT) could guide the percutaneous coronary intervention (PCI) of chronic total occlusion (CTO). We enrolled patients who were confirmed to have at least one native coronary artery CTO by DSCT before they underwent selective PCI in the period from December 2007 to October 2008. A CTO was defined as an obstruction of a native coronary artery with no luminal continuity. The CT-guided PCI procedure involved placing CT and fluoroscopic images side-by-side on the screen. DSCT images were analyzed for location, segment, plaque characteristics, calcification, and proximal lumen diameter of the CTO before PCI. The guidewire was advanced and manipulated under CT guidance. The PCI was carried out and the results were compared. Seventy-four CTOs were assessed. PCI was successful in 57 cases of CTOs (77.0%). According to the results, CTOs were divided into two groups: successful-PCI and failed-PCI. All coronary artery paths of CTOs were clearly recognized by DSCT. In the successful-PCI group, soft plaques were detected much more often than those in the failed-PCI group, but fibrous and calcified plaques were seen more often in the failed-PCI group. Calcification severity in CTO segments showed a significant difference between the groups (P=0.014). Calcified plaques were detected in 20 (35.1%) lesions in the successful-PCI group. More than 70% of the failures were calcified plaques, of which there were two arc-calcified and one circular-calcified lesions. Occlusions were longer in the failed-PCI group than those in the successful-PCI group [(38.8 +/- 25.0) vs. (18.0 +/- 15.3) mm, respectively, P < 0.01]. Fewer guidewires were used in the successful-PCI group compared with the failed-PCI group (1.7 +/- 1.0 vs. 2.5 +/- 0.9, respectively, P < 0.01). The logistic regression analysis indicated that predictors of recanalization of CTOs included occlusion length (P=0.0035, risk ratio (RR)=0.93) and calcification severity (P=0.05, RR=0.27). Multi-linear trends analysis showed that the factors affecting procedural time were CTO location (P=0.0141) and occlusion length (P=0.0035). DSCT could delineate the path of CTOs and characterize plaques. The outcomes of PCI were related to thrombolysis in myocardial infarction (TIMI) flow grade, CTO characteristics, severity of calcified plaques, and the length of occlusive segments. Occlusion length and calcification severity were independent predictors of CTOs. Occlusion length and CTO segments could also help to estimate the duration of interventional procedures.
引用
收藏
页码:568 / 574
页数:7
相关论文
共 14 条
  • [1] Characterization of coronary atherosclerosis by dual-source computed tomography and HU-based color mapping: a pilot study
    Brodoefel, H.
    Reimann, A.
    Heuschmid, M.
    Tsiflikas, I.
    Kopp, A. F.
    Schroeder, S.
    Claussen, C. D.
    Clouse, M. E.
    Burgstahler, C.
    [J]. EUROPEAN RADIOLOGY, 2008, 18 (11) : 2466 - 2474
  • [2] GAI LY, 2008, CHINESE J GERIATRIC, V5, P331
  • [3] Accuracy of multidetector spiral computed tomography in identifying and differentiating the composition of coronary atherosclerotic plaques - A comparative study with intracoronary ultrasound
    Leber, AW
    Knez, A
    Becker, A
    Becker, C
    von Ziegler, F
    Nikolaou, K
    Rist, C
    Reiser, M
    White, C
    Steinbeck, G
    Boekstegers, P
    [J]. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2004, 43 (07) : 1241 - 1247
  • [4] LIBBY P, 2007, BRAUNWALDS HEART DIS, P492
  • [5] Initial experience and safety in the treatment of chronic total coronary occlusions with a new optical coherent reflectometry-guided radiofrequency ablation guidewire
    Ng, W
    Chen, WH
    Lee, PY
    Lau, CP
    [J]. AMERICAN JOURNAL OF CARDIOLOGY, 2003, 92 (06) : 732 - 734
  • [6] Immediate results and one-year clinical outcome after percutaneous coronary interventions in chronic total occlusions - Data from a multicenter, prospective, observational study (TOAST-GISE)
    Olivari, Z
    Rubartelli, P
    Piscione, F
    Ettori, F
    Fontanelli, A
    Salemme, L
    Giachero, C
    Di Mario, C
    Gabrielli, G
    Spedicato, L
    Bedogni, F
    [J]. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2003, 41 (10) : 1672 - 1678
  • [7] Preliminary experience with the frontrunner coronary catheter: Novel device dedicated to mechanical revascularization of chronic total occlusions
    Orlic, D
    Stankovic, G
    Sangiorgi, G
    Airoldi, F
    Chieffo, A
    Michev, I
    Montorfano, M
    Carlino, M
    Corvaja, N
    Finci, L
    Colombo, A
    [J]. CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, 2005, 64 (02) : 146 - 152
  • [8] PERCUTANEOUS REVASCULARIZATION OF CHRONIC CORONARY OCCLUSIONS - AN OVERVIEW
    PUMA, JA
    SKETCH, MH
    TCHENG, JE
    HARRINGTON, RA
    PHILLIPS, HR
    STACK, RS
    CALIFF, RM
    [J]. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1995, 26 (01) : 1 - 11
  • [9] Novel method for real-time hybrid cardiac CT and coronary angiography image registration: visualising beyond luminology, proof-of-concept
    Roguin, Ariel
    Abadi, Sobhi
    Engel, Ahuva
    Beyar, Rafael
    [J]. EUROINTERVENTION, 2009, 4 (05) : 648 - 653
  • [10] RESULTS OF CORONARY ANGIOPLASTY OF CHRONIC TOTAL OCCLUSIONS (THE NATIONAL-HEART,-LUNG,-AND-BLOOD-INSTITUTE 1985-1986 PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY REGISTRY)
    RUOCCO, NA
    RING, ME
    HOLUBKOV, R
    JACOBS, AK
    DETRE, KM
    FAXON, DP
    FAXON, DP
    KELLETT, MA
    SANBORN, T
    JACOBS, AK
    ERARIO, M
    KING, SB
    DOUGLAS, J
    SUTOR, C
    KENT, KM
    EWELS, C
    KEHOE, K
    BLOCK, PC
    BLOCK, E
    HOLMES, DR
    VLIETSTRA, RE
    REEDER, GS
    BRESNAHAN, JF
    BRESNAHAN, DR
    BOVE, AA
    VONHAMMES, L
    BREVIG, S
    ALBASSEM, M
    LANCE, D
    BENTIVOGLIO, LG
    SHAPPELL, E
    COWLEY, MJ
    VETROVEC, GW
    LEWIS, SA
    DISCIASCIO, G
    KELLY, K
    GOSSELIN, AJ
    SWAYE, PS
    VIGNOLA, PA
    YON, H
    BOURASSA, MG
    DAVID, PR
    LABBE, M
    FAILLE, C
    CANNON, RO
    LEON, M
    MINCEMOYER, R
    MYLER, RK
    STERTZER, SH
    CLARK, DA
    [J]. AMERICAN JOURNAL OF CARDIOLOGY, 1992, 69 (01) : 69 - 76