Rubinshtein Ronen, Ben-Dov Nissan, Halon David A, Lavi Idit, Finkelstein Ariel, Lewis Basil S, Jaffe Ronen
Cardiology Department, Lady Davis Carmel Medical Center, Haifa, Israel.
EuroIntervention. 2015 Jul;11(3):301-7. doi: 10.4244/EIJV11I3A57.
Accurate positioning of aorto-ostial coronary stents is challenging. Coronary CT angiography (CCTA) allows detailed imaging of the coronary sinuses and implanted stents. We utilised CCTA to evaluate the accuracy of aorto-ostial stenting and to assess the efficacy of conventional angiography for guiding these procedures.
We analysed 256-row CCTA scans in 23 patients who had undergone aorto-ostial stenting. Optimal stent positioning was defined as presence of the entire circumference of the proximal stent edge within an aorto-ostial landing zone (AOLZ), located within 1 mm of the aorto-ostial plane. Geographic miss was diagnosed when at least a section of the proximal stent edge was located proximal or distal to the AOLZ. CCTA findings were compared with review of the conventional two-dimensional implantation angiogram (two experienced operators). By CCTA, the entire circumference of the proximal stent edge was located within the AOLZ in only three (13%) cases, with geographic miss in the remainder. Conversely, conventional coronary angiography suggested complete lesion coverage to be present in 95% of cases and optimal location of the proximal stent edge within the AOLZ in 76%.
Geographic miss was common in aorto-ostial stenting and was underestimated by conventional two-dimensional angiography.
主动脉开口处冠状动脉支架的准确定位具有挑战性。冠状动脉CT血管造影（CCTA）能够对冠状窦和植入的支架进行详细成像。我们利用CCTA评估主动脉开口处支架置入的准确性，并评估传统血管造影在指导这些操作中的有效性。
我们分析了23例接受主动脉开口处支架置入患者的256排CCTA扫描图像。最佳支架定位定义为近端支架边缘的整个圆周位于主动脉开口着陆区（AOLZ）内，该区域位于主动脉开口平面1毫米范围内。当近端支架边缘至少有一部分位于AOLZ近端或远端时，诊断为位置偏差。将CCTA结果与传统二维植入血管造影（两位经验丰富的操作人员）的评估结果进行比较。通过CCTA，仅3例（13%）近端支架边缘的整个圆周位于AOLZ内，其余病例存在位置偏差。相反，传统冠状动脉造影显示95%的病例病变完全覆盖，76%的病例近端支架边缘位于AOLZ内。
主动脉开口处支架置入时位置偏差很常见，且传统二维血管造影对其估计不足。
