| Background and purpose: Traditional coronary angiography was used to diagnose chronic total occlusion of coronary artery as the gold standard.The common anatomical morphology of occluded vascular calcification revealed by coronary angiography was evaluated.Preoperative evaluation of percutaneous coronary intervention for chronic total occlusion of coronary artery.The difficulty of surgery and the value of predicting the failure rate of surgery.Materials and methods: Retrospective analysis of 1323 patients with suspected or diagnosed coronary heart disease from February 2010 to August 2016.At least 1 coronary artery was completely occluded by conventional coronary angiography.The occlusion time was more than 3 months,and the coronary CTA was performed within 30 days.According to the inclusion and exclusion criteria,60 patients were finally selected.Morphological indicators of 60 coronary CTO lesions,including occlusion calcification(calcification position,short axial calcification,long axial calcification length),and occlusion proximal fibers,were evaluated by an experienced imaging physician through coronary CTA assessment.The shape of the cap,the length of the occlusion segment,and the occlusion segment are also recorded;and the J-CTO score of the CTO lesion is calculated according to the above morphological results.Compared with the final PCI results,univariate analysis was used to obtain morphological indicators predicting failure of the interventional procedure and the diagnostic efficacy of the improved-CTO score and the J-CTO score using the ROC curve.Results: A total of 60 patients were included in the study,with an average age of 63.02 ± 9.8 years,including 50 male patients and 10 female patients.Hypertension,hyperlipidemia,hyperuricemia and diabetes were commonin the enrolled patients.patients.The average duration of the disease was 10.5±3.1 months(1-30 months).Most patients had angina(41 cases)and myocardial infarction(13 cases).Clinical manifestations,1 case of previous PCI failed,the lesion location was mainly distributed in the anterior descending branch(25 cases,41.67%),circumflex artery(8 cases,13.33%),right coronary artery(27 cases,45%).A total of 42 patients with 42 coronary CTO lesions were successfully operated.18 patients with 18 coronary CTO lesions failed the interventional procedure,and the success rate of PCI intervention was 70%.There were significant differences in the severity and severity of calcification in the CTO lesions in the successful and failed groups,the blunt fibrous cap morphology in the CTO occlusion segment,the length of the CTO occlusion segment > 20 mm,and the anatomical features of the CTO occlusion segment.The difference was statistically significant(P > 0.05).At the same time,with the improvement of the grades of C-CTO and J-CTO,the coronary CTO lesions are more and more complicated,the difficulty of interventional surgery is increased step by step,and the success rate is gradually reduced.The improved-CTO score predicts the guidewire through occlusion lesions.The success rate was higher than the J-CTO score,and the difference was statistically significant(0.775 vs 0.763,P > 0.001).Conclusion: Coronary CTA examination revealed severe and severe calcification of the occlusion segment of the CTO lesion,blunt fibrous cap at the proximal end of the occlusion segment,distortion of the occlusion segment(bending degree > 45°),and length of the occlusion segment(> 20 mm)anatomical features.It is helpful to predict the failure of interventional surgery for coronary CTO lesions,and the assessment of occlusion calcification in the short axis is significant.Compared with the J-CTO score,the modified-CTO score has a better predictive effect on the success rate of interventional surgical guidewire through occlusion lesions,which can better assess the ease of interventional surgery and help to screen appropriate patients for acceptance.Interventional therapy improves the success rate of interventional surgery and reduces surgical complications. |
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