Department of Cardiology, Chinese PLA General Hospital, Beijing, China.
J Zhejiang Univ Sci B. 2010 Aug;11(8):568-74. doi: 10.1631/jzus.B1001013.
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.
本研究旨在探讨双源 CT（DSCT）是否可用于指导慢性完全闭塞（CTO）的经皮冠状动脉介入治疗（PCI）。
我们招募了 2007 年 12 月至 2008 年 10 月期间在选择性 PCI 前通过 DSCT 证实至少有一条原生冠状动脉 CTO 的患者。CTO 定义为原生冠状动脉的阻塞，无管腔连续性。在 CT 引导下进行 CTO 引导的 PCI 程序，将 CT 和荧光透视图像并排显示在屏幕上。在 PCI 前分析 CTO 的位置、节段、斑块特征、钙化和近端管腔直径。在 CT 引导下推进和操纵导丝。进行 PCI 并比较结果。
评估了 74 个 CTO。57 例 CTO 的 PCI 成功（77.0%）。根据结果，CTO 分为两组：PCI 成功组和 PCI 失败组。所有 CTO 的冠状动脉路径均通过 DSCT 清晰识别。在 PCI 成功组中，检测到的软斑块比 PCI 失败组多，但 PCI 失败组中纤维和钙化斑块更多。CTO 节段的钙化严重程度在两组之间有显著差异（P=0.014）。在 PCI 成功组中，20 个（35.1%）病变中检测到钙化斑块。超过 70%的失败是钙化斑块，其中有两个弧形钙化和一个环形钙化病变。与 PCI 成功组相比，PCI 失败组的闭塞更长[（38.8+/-25.0）比（18.0+/-15.3）mm，分别，P<0.01]。与 PCI 失败组相比，PCI 成功组使用的导丝更少（1.7+/-1.0 比 2.5+/-0.9，分别，P<0.01）。逻辑回归分析表明，CTO 再通的预测因素包括闭塞长度（P=0.0035，风险比（RR）=0.93）和钙化严重程度（P=0.05，RR=0.27）。多线性趋势分析表明，影响手术时间的因素是 CTO 位置（P=0.0141）和闭塞长度（P=0.0035）。
DSCT 可描绘 CTO 的路径并对斑块进行特征描述。PCI 的结果与心肌梗死溶栓治疗（TIMI）血流分级、CTO 特征、钙化斑块严重程度和闭塞节段长度有关。闭塞长度和钙化严重程度是 CTO 的独立预测因素。闭塞长度和 CTO 节段也有助于估计介入治疗的持续时间。
