计算机断层血管造影在经导管血管造影结果不确定时预测左前降支可移植性的作用。

The Role of Computed Tomographic Angiography in Predicting Left Anterior Descending Artery Graftability When Catheter Angiography is Inconclusive.

机构信息

King Fahad Specialist Hospital Buraydah, Prince Sultan Cardiac Center Qassim (PSCCQ), Buraydah.

King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King ABdulAziz Cardiac Center, Ministry of National Guard, Health Affairs, Saudi Arabia.

出版信息

J Thorac Imaging. 2018 Jan;33(1):55-59. doi: 10.1097/RTI.0000000000000308.

DOI:10.1097/RTI.0000000000000308

PMID:29076918

Abstract

PURPOSE

Graftability of the left anterior descending artery (LAD) has important prognostic value for coronary artery bypass graft (CABG) surgery. However, with a chronic total occlusion (CTO) of the LAD, invasive coronary angiography (ICA) may be insufficient to determine its graftability. We evaluated the role of coronary computed tomographic angiography (CTA) in the assessment of CTO and LAD graftability when the distal vessel segment was incompletely visualized by ICA.

MATERIALS AND METHODS

We enrolled 31 patients with equivocal eligibility for CABG due to CTO of the LAD with poor distal flow defined by ICA. Patients with LAD diameters ≥1.5 mm by CTA underwent CABG surgery, and the vessel diameter was reassessed intraoperatively.

RESULTS

The mean age was 54±14 years. Seven patients (23%) had suitable LAD targets on CTA and underwent successful CABG. Another 24 patients (77%) had nongraftable LADs. Patients with a graftable LAD showed no significant difference between mean LAD diameter measured by CTA and during surgery (1.6±0.3 vs. 1.5±0.3 mm, P=0.21). The preoperative left ventricular ejection fraction was not significantly different between groups (35%±8% vs. 35%±7%, P=0.2). However, after a mean follow-up of 21±7 months, left ventricular ejection fraction was significantly higher in vascularized patients (41%±5.8% vs. 34%±8%, P=0.01, respectively). Six of 7 patients had patent LAD grafts on CTA at 1-year follow-up.

CONCLUSION

CTA may provide valuable information about chronically occluded LAD size and graftability when ICA is inconclusive.

摘要

目的

左前降支（LAD）的可移植性对冠状动脉旁路移植术（CABG）具有重要的预后价值。然而，对于 LAD 的慢性完全闭塞（CTO），侵入性冠状动脉造影（ICA）可能不足以确定其可移植性。我们评估了冠状动脉计算机断层血管造影（CTA）在 ICA 不能完全显示远端血管节段的情况下，对 CTO 和 LAD 可移植性的评估作用。

材料和方法

我们招募了 31 名因 LAD CTO 伴 ICA 定义的远端血流较差而有 CABG 手术适应证的患者。CTA 显示 LAD 直径≥1.5mm 的患者接受 CABG 手术，并在术中重新评估血管直径。

结果

患者的平均年龄为 54±14 岁。7 名患者（23%）在 CTA 上有合适的 LAD 靶标，并成功接受了 CABG。另外 24 名患者（77%）的 LAD 不可移植。可移植 LAD 的患者在 CTA 测量的 LAD 平均直径与术中测量的直径之间没有显著差异（1.6±0.3 与 1.5±0.3mm，P=0.21）。术前左心室射血分数在两组之间没有显著差异（35%±8%与 35%±7%，P=0.2）。然而，在平均 21±7 个月的随访后，血管化患者的左心室射血分数显著更高（41%±5.8%与 34%±8%，分别为 P=0.01）。在 1 年的随访中，有 6 名患者的 LAD 移植血管在 CTA 上保持通畅。