Stent Parameter Of Percutaneous Coronary Intervention:compared With Preoperative Coronary Computed Tomographic Angiography

PART 1: Distribution and morphology of coronary atherosclerotic plaques by computed tomographic coronary angiographyObjective: Investigate the morphology and distribution of coronary atherosc lerotic plaques by multi-detectorspiral computed tomographic coronary angiograp hy.Methods: Radiographic data of 825 patients who underwent multislice spiral CT coronary angiography(computed tomographic coronary angiography, CCTA) in Huanghe hospital affiliated to Henan Science and Technology University from Jan 2012 to May 2013 was retrospectively analyzed. According to the AHA classification,the coronary artery tree was divided into 16 segments.The coronary plaques were divided into 3 types: the non-calcified, the calcified plaques, and the mixed plaques according to plaque ingredients. And according to the morphology type, the plaques were divided into focal plaque, segmental plaque, and diffuse plaque. And the coronary artery stenosis caused by atherosclerosis was divided into: mild stenosis, moderate stenosis and severe stenosis. Results:(1) There were 825 patients enrolled in this study(536 were male and 289 were female). Coronary atherosclerotic plaque was found in 313 cases(37.94%) through CCTA. In 536 male patients, coronary atherosclerotic plaque was found in 229 cases, with the incidence of 42.73%. In 289 female cases, 84 patients have coronary atherosclerotic plaque, with the incidence of 29.06%. The incidence ratio between male and female is 1.46, the incidence rate of the disease is much higher in male than that in female, and the difference was statistically significant. The positive rate and the degree of stenosis of coronary atherosclerosis increased with age.(2) In the 313 patients, coronary atherosclerotic plaques were finally found in the 584 vascular segments. There were 316 non-calcified plaques(54.1%), 139 calcified plaques(23.8%) and 129 mixed plaques(22.1%). Except LAD, all 15 coronary sections were involved. Non-calcified plaques were most often seen in the LAD-6 segment(72 plaques, 12.5%), followed by LAD-7(54 plaques, 9.2%), RCA-2(36 plaques, 6.2%). Calcified plaques were most often seen in the LAD-6 segment(32 plaques, 5.4%), followed by LAD-7(24 plaques, 4.1%), RCA-2(15 plaques, 2.5%). Mixed plaques were most often seen in the LAD-6 segment(29 plaques, 4.9%), followed by LAD-7(24 plaques, 4.1%), RCA-2(23 plaques, 3.9%). LAD was the most easily involved with 247 plaques(42.2%), followed by RCA with136 plaques(23.2%), and LCX was the rarest with 91 plaques(15.6%).Conclusions: The occurrence and degree of stenosis coronary atherosclerosis are age and gender related. The elder people have a higher morbidity and more severe stenosis. The number of male patients was higher than that in female. Myocardial bridge detection rate of CCTA was significantly higher than that of conventional coronary angiography. And the study does not prove that the relationship between myocardial bridge and cardiovascular events.PART 2: Stent Parameter of Percutaneous Coronary Intervention :Compared with Preoperative Coronary Computed Tomographic AngiographyObjective To analyze the correlation and difference of stent parameter prodicted by using coronary computed tomographic angiography(CCTA) with that finally inplanted in percutaneous coronary intervention(PCI).Methods Thirty patients with 50 lesions were enrolled in this prospective study. Multi-slice detector spiral computed tomography(MSCT) forms coronaryartery angiography by Single sector reconstruction and retrospective electrocardi ographically-gated method.The cardiac phase in 75% of the R-R interval was an alyzed using a dedicated CT workstation EBW4.5(Philips Extended Brilliance Workspace,Philips Medical Systems,Cleveland,OH).Exclude patients whoseCCTA with uninterpretable images secondary to motion artifact The length of t he lesion on CCTA was measured manually on strightened multiplanar reconstru ctions.The proximal and distal ends of the lesion were identified.and the diamet ers were measures using automated software.and the mean diameter for the nor mal to normal segment was calculated[(proximal diameter+diatal diameter)/2].CT A predicted stent length=lesion length,CTA predicted stent diameter=the mean di ameter for the normal to normal segment.The PCI were acquired on a Siemens Artis d FA digital subtraction angiography equipment with the patient in the supi ne position using the Seldinger technique via the percutaneous radial arterial cat heterization.Nonionic contrast Iodine amine 370(370mg I/ml)was used.The six angiography posture inclued left head position,left foot position,head position,rig ht head position,right foot position.LM,LAD,LCX,RCA were clearly showed.In a ddition,the two images with 900 angiographic angle of Vertical long axis of the s tents were provided.Two blined interventionalcardiologists determined the stent si zing.The number of stents,diameter,total length and position were recorded,The s tent diameter(CTA-Stent D) and length(CTA-Stent L) were evluated by using CCTA pre-operatively,and compared with the diameter(CAG-Stent D) and lengt h(CAG-Stent L) finally used in PCI.Results(1) There were significant correlations between CTA-Stent D and CAGStent D(r=0.860,P<0.05) and between CTA-Stent L and CAG-Stent L(r=0.680,P<0.05).(2) There was significant statistical difference between the CTA-Stent L and the CAG-Stent L(t=-2.680,P<0.05). In 43 lesions(86.0%), the lengths of CTA-Stent L were longer than that of CAG Stent-L.Conclusions There are significant correlations between CCTA and CAG based stent sizing in an experienced setting. The lengths of stent predicted by CCTA are longer than that of stent finally implanted, which should be a focus of clinical attention...