Allahwala Usaid K, Ward Michael R, Bhindi Ravinay
Department of Cardiology, Royal North Shore Hospital, Reserve Rd, St. Leonards, Sydney, 2065, Australia.
Cardiovasc Interv Ther. 2018 Oct;33(4):345-349. doi: 10.1007/s12928-017-0491-8. Epub 2017 Sep 26.
Coronary chronic total occlusions (CTO) occur when there is complete, or near complete occlusion of a vessel, angiographically appreciated by the presence of a collateral circulation with late filling of the occluded vessel. With restoration of anterograde blood flow there is alteration in vascular wall stress which may influence distal vessel size. We sought to determine if the distal vessel size changes following revascularization of the CTO. We retrospectively reviewed patients who underwent successful CTO revascularization and who subsequently underwent repeat angiography. We measured the size of the vessel proximal and distal to the stented segment to assess for change in luminal diameter. Thirty-seven successful CTO revascularization procedures were reviewed. The mean age was 70.3, with 81% male. The most commonly revascularised artery was the right coronary artery (RCA). The median time between angiograms was 194 days. The indexed luminal diameter distal to the stented segment had a greater increase in size compared to the proximal segment (31.1 vs 4.8%, p < 0.0001). The increase in distal vessel was seen in both RCA (34.5 vs 8%, p < 0.001) and non-RCA (28.7 vs 1.9%, p < 0.001). The distal vessel had a more marked increase in distal luminal diameter if there was no resting hypokinesis in the territory supplied by the CTO (35.6 vs 15.0%, p < 0.01). The luminal diameter distal to a revascularized CTO has a greater increase in size compared to the proximal vessel and persists over time. This may have implications on determining stent sizing during CTO procedures as well as determining suitable vessels for attempted revascularization.
当血管出现完全或近乎完全闭塞时，冠状动脉慢性完全闭塞（CTO）就会发生，血管造影显示存在侧支循环且闭塞血管延迟显影即可明确这一点。随着顺行血流的恢复，血管壁应力会发生改变，这可能会影响远端血管的大小。我们试图确定CTO血管重建术后远端血管大小是否会发生变化。我们回顾性分析了成功进行CTO血管重建且随后接受了重复血管造影的患者。我们测量了支架段近端和远端血管的大小，以评估管腔直径的变化。共回顾了37例成功的CTO血管重建手术。平均年龄为70.3岁，男性占81%。最常进行血管重建的动脉是右冠状动脉（RCA）。两次血管造影之间的中位时间为194天。与近端段相比，支架段远端的指数化管腔直径增大更为明显（31.1%对4.8%，p<0.0001）。RCA（34.5%对8%，p<0.001）和非RCA（28.7%对1.9%，p<0.001）的远端血管均出现增大。如果CTO供血区域没有静息性运动减弱，则远端血管的远端管腔直径增加更为显著（35.6%对15.0%，p<0.01）。与近端血管相比，CTO血管重建术后远端的管腔直径增大更为明显，且会持续一段时间。这可能对CTO手术期间确定支架尺寸以及确定适合进行血管重建尝试的血管有影响。
