Stähli B E, Bonassin F, Goetti R, Küest S M, Frank M, Altwegg L A, Gebhard C, Levis A, Wischnewsky M B, Lüscher T F, Alkadhi H, Kaufmann P A, Maier W
Department of Cardiology, Cardiovascular Center, University Hospital Zürich, Switzerland.
J Invasive Cardiol. 2012 May;24(5):196-201.
Coronary computed tomography angiography (CCTA) provides information regarding lesion morphology and three-dimensional coronary anatomy incremental to coronary angiography. We addressed the question whether preprocedural CCTA bears potential for guiding percutaneous coronary interventions (PCI).
Sixty-six coronary lesions attempted with PCI within 6 months of preprocedural CCTA were retrospectively assessed. Lesion parameters from unenhanced computed tomography (CT) for calcium scoring and CCTA were analyzed and compared with PCI complexity. Complex PCI was defined as use of buddy wire, kissing balloon, necessity of high pressure balloons, or rotablator. Complex PCIs were observed in 32 interventions (48%). Median Agatston score and Hounsfield units were higher in lesions with complex as compared to those with non-complex interventions with 130 (interquartile range, 23-276) vs 29 (0-158; P=.01), and 493 (245-631) vs 341 (68-520 Hounsfield Units; P=.04), respectively. Median local plaque volume and plaque mass were higher in complex PCI with 17 (2-39) vs 5 (0-19.5 mm³; P=.007), and 48 (15-99) vs. 16 (1.5-63 mg hydroxyapatite/mm³; P=.03), respectively. Lesions leading to complex PCI were longer [1.8 (1.2-2.8) vs 1.3 (0.8-1.7) cm; P=.03], and had a higher rate of calcified plaques (23% vs 3%; P=.03). There was a significant correlation between CCTA- and angiography-derived local SYNTAX Scores (P<.001); the CCTA-derived score seems to be predictive for failed and complex PCI (area under curve = 0.75 ± 0.13 and 0.66 ± 0.08, respectively).
Preprocedural lesion assessment by CCTA indicates complexity of PCI. In patients with suspected complex coronary anatomy, prior CCTA adds important information for planning PCI.
冠状动脉计算机断层扫描血管造影（CCTA）可提供有关病变形态和冠状动脉三维解剖结构的信息，这些信息是冠状动脉造影所补充的。我们探讨了术前CCTA是否具有指导经皮冠状动脉介入治疗（PCI）的潜力。
回顾性评估了在术前CCTA后6个月内尝试进行PCI的66处冠状动脉病变。分析了用于钙化评分的非增强计算机断层扫描（CT）和CCTA的病变参数，并与PCI的复杂性进行了比较。复杂PCI定义为使用辅助导丝、双球囊、高压球囊或旋磨术。在32例干预中观察到复杂PCI（占48%）。与非复杂干预的病变相比，复杂病变的阿加斯顿评分中位数和亨氏单位更高，分别为130（四分位间距，23 - 276）对29（0 - 158；P = 0.01），以及493（245 - 631）对341（68 - 520亨氏单位；P = 0.04）。复杂PCI的局部斑块体积中位数和斑块质量更高，分别为17（2 - 39）对5（0 - 19.5立方毫米；P = 0.007），以及48（15 - 99）对16（1.5 - 63毫克羟基磷灰石/立方毫米；P = 0.03）。导致复杂PCI的病变更长[1.8（1.2 - 2.8）对1.3（0.
