Pregowski Jerzy, Jastrzebski Jan, Kępka Cezary, Kruk Mariusz, Ciszewski Michał, Wolny Rafał, Zalewska Joanna, Chmielak Zbigniew, Karcz Maciej, Witkowski Adam
Institute of Cardiology, Warsaw, Poland.
Postepy Kardiol Interwencyjnej. 2013;9(2):115-20. doi: 10.5114/pwki.2013.35444. Epub 2013 Jun 17.
The findings from intravascular ultrasound studies on the impact of calcium deposits on the results of stent implantation are conflicting.
To evaluate whether calcium deposits as assessed by (CTCA) influence results of stent deployment.
The study population comprised 60 patients (43 male; age 64.2 ±8.6 years) who underwent CTCA before stent implantation. Lesion calcium score, total calcium length, and maximal area and maximal thickness of calcium deposits within the lesion segment were assessed. Plaques were divided into those with calcium score ≥ median (group 1), calcium score < median (group 2), and without calcium (group 3). Intravascular ultrasound (IVUS) was performed after attainment of optimal angiographic results of the stent procedure. Focal and diffuse stent expansion was defined as either minimum stent area (MSA) or mean stent area over the length of the stent divided by reference lumen area.
The proximal reference segments of lesions with higher calcium score contained a larger plaque burden (47 ±12% vs. 41 ±9% vs. 34 ±18%, p = 0.02) - respectively for groups 1, 2, and 3. Positive correlation was observed between lesion calcium score and frequency of post-dilation (R = 0.28, p = 0.03). There was no difference in focal stent expansion (71 ±14% vs. 65 ±15% vs.71 ±15%, p = 0.3) or diffuse stent expansion (92 ±30% vs. 85 ±30% vs. 93 ±38%, p = 0.7) comparing groups 1, 2, and 3. Lesion calcium score, total length of calcium, and maximum area and thickness of calcium deposits did not correlate with focal or diffuse stent expansion.
Lesions with a higher CTCA calcium score had larger reference plaque burden after stent implantation and more likely required post-dilation, but final stent expansion as assessed by IVUS was not affected by the amount of CTCA calcium provided an angiographically optimal result was achieved.
血管内超声研究关于钙沉积对支架植入结果影响的发现相互矛盾。
评估通过（CTCA）评估的钙沉积是否会影响支架置入结果。
研究人群包括60例患者（43例男性；年龄64.2±8.6岁），这些患者在支架植入前接受了CTCA检查。评估病变钙评分、总钙长度以及病变节段内钙沉积的最大面积和最大厚度。斑块分为钙评分≥中位数的斑块（第1组）、钙评分<中位数的斑块（第2组）和无钙斑块（第3组）。在支架手术获得最佳血管造影结果后进行血管内超声（IVUS）检查。局灶性和弥漫性支架扩张定义为最小支架面积（MSA）或支架长度上的平均支架面积除以参考管腔面积。
钙评分较高的病变的近端参考节段含有更大的斑块负荷（第1组、第2组和第3组分别为47±12%对41±9%对34±18%，p = 0.02）。观察到病变钙评分与后扩张频率之间存在正相关（R = 0.28，p = 0.03）。比较第1组、第2组和第3组，局灶性支架扩张（71±14%对65±15%对71±15%，p = 0.3）或弥漫性支架扩张（92±30%对85±30%对93±38%，p = 0.7）没有差异。病变钙评分、钙的总长度以及钙沉积的最大面积和厚度与局灶性或弥漫性支架扩张均无相关性。
CTCA钙评分较高的病变在支架植入后具有更大的参考斑块负荷，更有可能需要进行后扩张，但如果获得了血管造影最佳结果，通过IVUS评估的最终支架扩张不受CTCA钙量的影响。
