Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, Eunpyeong St. Mary's Hospital, Seoul, Republic of Korea.
Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
J Cardiol. 2021 Jan;77(1):65-71. doi: 10.1016/j.jjcc.2020.07.011. Epub 2020 Oct 26.
Restoration of anterograde blood flow leads to alterations in vascular wall stress that may influence lumen size distal to chronic total occlusion (CTO) lesions. We sought to assess changes in lumen diameter of segments distal to the stent segment of successfully recanalized CTO.
We analyzed 507 consecutive CTO cases with stent implantation that underwent follow-up angiography at a single high-volume center (mean follow-up of 13.5 months). Segments ≤40 mm distal to the stent edge were analyzed using quantitative coronary angiography.
At follow-up, lumen diameters significantly increased; diameter changes of 0.26 ± 0.47 (percent diameter change of 18.2%) at 5 mm distal, mean lumen diameter changes of 0.23 ± 0.35 (14.3%) and minimal lumen diameter changes of 0.22 ± 0.80 (24.7%) (all p < 0.001). Lumen enlargement was similar between visually shrunken and stenosed vessels (degree of stenosis ≥20% with luminal irregularities) distal to stents; 5 mm distal (0.32 ± 0.48 vs. 0.30 ± 0.48, p = 0.76), mean lumen diameter changes (0.26 ± 0.37mm vs. 0.26±0.33 mm, p = 0.94), minimal lumen diameter changes (0.28 ± 0.43 mm vs. 0.22 ± 1.30 mm, p = 0.48). There was no association between degree of in-stent narrowing and changes in distal lumen diameter (Spearman r = -0.02, p = 0.59). Multivariate logistic regression for the predictors of greater lumen enlargement indicated that patients with left ventricle dysfunction (ejection fraction ≤45%) had greater enlargement [odds ratio (OR): 2.53, 95% confidence interval (CI): 1.23-5.23, p = 0.01]. Conversely, a low hematocrit (male <40%, and female <35%) was associated with attenuated lumen enlargement (OR: 0.68 95% CI: 0.47-0.98; p = 0.04).
Lumen diameter distal to CTO lesions significantly increased following successful revascularization, regardless of diseased status of the distal bed or degree of in-stent narrowing. These findings implicate appropriate determination of stent size, stent coverage length, as well as management strategies of distal vessels.
恢复顺行血流会导致血管壁应力发生变化，这可能会影响慢性完全闭塞（CTO）病变远端的管腔大小。我们旨在评估成功再通的 CTO 病变支架段远端节段管腔直径的变化。
我们分析了在一家高容量中心接受随访血管造影的 507 例连续 CTO 病例（平均随访 13.5 个月），这些患者在支架植入后接受了随访。使用定量冠状动脉造影术分析支架边缘远端≤40mm 的节段。
在随访时，管腔直径显著增加；支架边缘远端 5mm 处的直径变化为 0.26±0.47（直径变化百分比为 18.2%），平均管腔直径变化为 0.23±0.35（14.3%），最小管腔直径变化为 0.22±0.80（24.7%）（均 p<0.001）。支架远端可见狭窄或不规则的血管（狭窄程度≥20%，伴有管腔不规则）的管腔扩张相似；支架边缘远端 5mm 处（0.32±0.48 与 0.30±0.48，p=0.76）、平均管腔直径变化（0.26±0.37mm 与 0.26±0.33mm，p=0.94）、最小管腔直径变化（0.28±0.43mm 与 0.22±1.30mm，p=0.48）。支架内狭窄程度与远端管腔直径变化之间无相关性（Spearman r=−0.02，p=0.59）。预测管腔更大扩张的多变量逻辑回归表明，左心室功能障碍（射血分数≤45%）的患者有更大的扩张[比值比（OR）：2.53，95%置信区间（CI）：1.23-5.23，p=0.01]。相反，低血细胞比容（男性<40%，女性<35%）与管腔扩张减弱相关（OR：0.68，95%CI：0.47-0.98；p=0.04）。
成功再通后 CTO 病变远端的管腔直径显著增加，无论远端床的病变状态或支架内狭窄程度如何。这些发现提示需要适当确定支架的大小、支架覆盖的长度以及远端血管的治疗策略。
