Department of Radiology, Shanghai No. 6 People's Hospital, School of Medicine, Shanghai Jiaotong University, 600 Yishan Rd, Shanghai, China 200233.
Radiology. 2013 Feb;266(2):443-51. doi: 10.1148/radiol.12120961. Epub 2012 Nov 30.
To evaluate the presence of linear intrathrombus enhancement in coronary total occlusion (CTO) lesions observed at coronary computed tomographic (CT) angiography and its correlation with the outcome of percutaneous coronary intervention (PCI).
All patients gave written informed consent, and the study protocol was approved by the hospital ethics committee. Consecutive patients with CTO confirmed at initial conventional coronary angiography were prospectively chosen to undergo a coronary CT angiography examination prior to their staged PCI. Linear intrathrombus enhancement was defined as a linear area of enhanced opacity traversing the nonopacified occluded segment with attenuation higher than 120 HU. Angiographic features, including lesion length, linear intrathrombus enhancement length, and calcification score, were measured at coronary CT angiography. Univariate and multivariate statistical tests were performed to identify variables associated with successful PCI.
Eighty patients with 88 CTO lesions were included in this study. Fifty-one lesions were successfully recanalized at PCI. Lesion length was longer in the PCI failure group (P = .043). Linear intrathrombus enhancement was observed in 30 (59%) of the 51 lesions successfully treated with PCI. However, linear enhancement was found in seven (19%) of 37 patients with failed PCI (P < .001 as compared with patients with successful PCI). Tortuous course was revealed to be the only angiographic parameter associated with unfavorable PCI outcome (P = .008). The presence of linear intrathrombus enhancement proved at multivariate analysis to be the only independent predictor of PCI success (odds ratio: 4.926; 95% confidence interval: 1.646, 14.74; P = .004).
The presence of coronary CT angiography-visible linear intrathrombus enhancement within the occluded segment predicts better outcome of PCI in CTOs.
评估冠状动脉计算机断层扫描（CT）血管造影中观察到的冠状动脉完全闭塞（CTO）病变中线性血栓内增强的存在及其与经皮冠状动脉介入治疗（PCI）结果的相关性。
所有患者均签署书面知情同意书，研究方案经医院伦理委员会批准。连续选择经初始常规冠状动脉造影证实为 CTO 的患者，在分期 PCI 前前瞻性进行冠状动脉 CT 血管造影检查。线性血栓内增强定义为贯穿未显影闭塞节段的线性增强密度区，其衰减值高于 120HU。在冠状动脉 CT 血管造影中测量包括病变长度、线性血栓内增强长度和钙化评分在内的血管造影特征。进行单变量和多变量统计检验，以确定与 PCI 成功相关的变量。
本研究共纳入 80 例 88 处 CTO 病变患者。51 处病变经 PCI 成功再通。PCI 失败组的病变长度更长（P =.043）。在 51 处成功接受 PCI 治疗的病变中，有 30 处（59%）观察到线性血栓内增强。然而，在 37 例 PCI 失败的患者中，有 7 处（19%）发现线性增强（与成功接受 PCI 的患者相比，P <.001）。迂曲的血管路径是与不良 PCI 结果相关的唯一血管造影参数（P =.008）。多变量分析显示，线性血栓内增强的存在是 PCI 成功的唯一独立预测因子（比值比：4.926；95%置信区间：1.646，14.74；P =.004）。
在 CTO 中闭塞节段内可见的冠状动脉 CT 血管造影线性血栓内增强的存在可预测 PCI 的更好结果。
