Ehara Mariko, Terashima Mitsuyasu, Kawai Masato, Matsushita Sunichi, Tsuchikane Etsuo, Kinoshita Yoshihisa, Kimura Masashi, Nasu Kenya, Tanaka Nobuyoshi, Fujita Hiroshi, Habara Maoto, Ito Tuyoshi, Rathore Sudhir, Katoh Osamu, Suzuki Takahiko
Department of Cardiology, Toyohashi Heart Center, Toyohashi-City, Aichi, Japan.
J Invasive Cardiol. 2009 Nov;21(11):575-82.
Percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) remains a challenge. Multislice computed tomographic coronary angiography (CTCA) allows noninvasive evaluation of the coronary artery by visualizing vessel trajectory and morphological features at the occluded site. The aim of this study was to assess the value of CTCA to predict the success of guidewire crossing in PCI to treat CTOs.
We performed CTCA in patients with CTOs (of > 3 months' duration); 110 lesions were scanned. Wiring success was defined as complete crossing of the guidewire past the occluded site. Correlation of the following morphological parameters with wiring success was analyzed: target vessel bending (defined as > 45 degrees), shrinkage, severe calcification, presence of side branches, stump morphology, in-stent occlusion and occlusion length.
Wiring success was obtained in 93 lesions (85%). In the unsuccessful group, bending, shrinkage and severe calcification were significantly higher compared to the successful group (76% vs. 18%, p < 0.0001; 29% vs. 4%, p = 0.0005; 41% vs. 18%, p = 0.0356, respectively). The wiring success rate was significantly lower in cases with bending, shrinkage and severe calcification (57% vs. 95%, p < 0.0001; 44% vs. 88%, p = 0.0005; 71% vs. 88%, p = 0.0356, respectively). Stump morphology, in-stent occlusion or occlusion length did not significantly affect the outcome. Multivariate analysis showed that bending, shrinkage and severe calcification remained significant independent predictors of wiring failure.
Bending, shrinkage and severe calcification are significant predictors for wiring success. CTCA provides a practical determinant of the outcomes in PCI to treat CTOs.
经皮冠状动脉介入治疗（PCI）慢性完全闭塞病变（CTO）仍然是一项挑战。多层螺旋计算机断层扫描冠状动脉造影（CTCA）通过可视化血管走行和闭塞部位的形态特征，对冠状动脉进行无创评估。本研究旨在评估CTCA预测PCI治疗CTO时导丝通过成功率的价值。
我们对CTO（病程>3个月）患者进行了CTCA检查；共扫描了110个病变。导丝通过成功定义为导丝完全穿过闭塞部位。分析了以下形态学参数与导丝通过成功的相关性：靶血管迂曲（定义为>45度）、狭窄、严重钙化、分支存在情况、残端形态、支架内闭塞和闭塞长度。
93个病变（85%）导丝通过成功。在未成功组中，迂曲、狭窄和严重钙化的发生率显著高于成功组（分别为76%对18%，p<0.0001；29%对4%，p = 0.0005；41%对18%，p = 0.0356）。存在迂曲、狭窄和严重钙化时导丝通过成功率显著降低（分别为57%对95%，p<0.0001；44%对88%，p = 0.0005；71%对88%，p = 0.0356）。残端形态、支架内闭塞或闭塞长度对结果无显著影响。多因素分析显示，迂曲、狭窄和严重钙化仍然是导丝通过失败的显著独立预测因素。
迂曲、狭窄和严重钙化是导丝通过成功的重要预测因素。CTCA为PCI治疗CTO的结果提供了一个实用的决定因素。
