| Objective:The multi-slide 64 CT has been widely used for diagnosing coronary heart disease with reasonably good accuracy.However,it is still unknown whether it could also be used to guide intervention of chronic total occlusion(CTO).Taking advantage of the difference in CT density,the occlusions can be seen clearly so that we know where to go.The aim of the study was to investigate whether multidetecter spiral computer tomography(MDCT) could guide the percutaneous coronary intervention(PCI) of CTO.Methods:The study enrolled the patients who were confirmed that there was at least one native coronary artery occlusion by MDCT before selective PCI from December 2007 to October 2008.A CTO was defined as obstruction of a native coronary artery with no luminal continuity.The CT guided PCI procedure involved placing the CT and fluoroscopic images side by side on the screen.All pts' MDCT images were analyzed for location,segment,plaque characteristics, calcification and proximal lumen diameter of CTO prior to PCI.Guide wire was advanced and manipulated under the guidance of CT images.Then PCI was performed and the results were compared.Results A total of 74 CTOs was enrolled.PCI was successful in 57 cases (77.0%).According to the result,all CTOs were divided into two groups: successful-PCI group and failure-PCI group.All coronary artery paths of CTOs were clearly recognized by MDCT.In the successful-PCI group,soft plaques were detected much more often than the failure-PCI group,but the fibrous and calcified plaques were more in failure-PCI group.The severity of calcified in CTOs segments were of a significant difference(P=0.014).Calcified plaques were detected in 20(35.1%) lesions in successful-PCI group.More than 70%failure were calcified plaque,including 2 arc-calcified and 1 circular-calcified.The CTOs presented with TIMI grade 1 were recanalized much easier(P=0.044).The occlusion was longer in failure-PCI group than in the successful-PCI group (38.8±25.0mm vs.18.0±15.3mm,respectively,P＜0.01).There were fewer guide wires in successful-PCI group,compared with the failure-PCI group(1.7±1.0 vs. 2.5±0.9,respectively,P＜0.01).The Logistic regression analysis indicated that predictors of realization of CTOs included the occlusion length(P=0.0035,RR = 0.93) and the severity of calcification(P=0.05,RR = 0.27).Multi-linear trends analysis showed that the factors affecting procedural time were the locations of CTOs(P=0.0141) and occlusion length(P=0.0035).Conclusion:MDCT can delineate the CTOs path and characterize the plaque.The outcome of PCI is related to the following factors:TIMI flow grade, characteristics of the CTOs,the severity of calcified plaques and the length of occlusive segment.The occlusion length and severity of the calcification are independent predictors of successful CTOs.At the same time,occlusion length and segment of CTOs can help estimate the interventional procedural duration. Objective:Compared with traditional invasive CAG,non-invasive coronary multi-detector computed tomography CT(MDCT) can visualize the stenosis of coronary artery lumen,as well as the character of atherosclerotic plaque.However, it is not clear whether MDCT could optimize the intervention procedure.Taking advantage of the CT angiography images instead of routine invasive CAG,the interventional strategy was determined before operation.The aim of the study was to investigate whether MDCT guided PCI could affect the complication,exposure time,volume of contrast and materials during the procedural,compared with non-MDCT guided PCI.Methods:The study population included the patients who were performed PCI in our department from August to October in 2008 years.All patients were divided into 2 groups:CT-guided PCI group and the control group --- non-CT -guided PCI group.In the control group,treatment strategy of procedural was decided by operator after conventional CAG.In CT-guided PCI group,MDCT was performed first to identify the lesions.By studying CT image,operator evaluated the location of culprit vessel,as well as branch,plaque characteristics, longth and diameter.The operator selected an appropriate projection(not have to perform regular CAG),guide wire and balloon himself to perform the operation. All complication,exposure time,volume of contrast and materials during the procedural were recorded.Results A total of 59 patients were enrolled.There were 20 pts in the MDCT guided PCI group and 39 pts in the control group.MDCT guided PCI group was involving 27 culprit vessels,of which 15(55.5%) artery were soft plaques.The approach of operation had no statistical difference between the two groups, neither the number of culprit artery,bifurcation and chronic totle occlusion. Exposure time in MDCT-guided PCI group shortened than control group(887.0±522.6s vs.1074.8±707.9s,P=0.2540).MDCT-guided PCI group,compared with control group,got fewer complications,volume of contrast(132.5±67.6ml vs. 181.5±71.2ml,P=0.01) and guide wires(1.2±0.4 pcs vs.1.7±0.9 pcs,P＜0.05). In MDCT- guided PCI group,one of the patients was found ST-T segments changes during the operation.However,three dissections and one ST-T segments changes developed in control group.Conclusion:Taking advantage of the CT angiography images to evaluate the culprit lesion,instead of routine invasive CAG,the interventional strategy was performed before operation,the complications of intervention,exposure time, volume of contrast and number of guide wires can be significantly decreased.
|
PDF Full Text Request