Department of Cardiovascular Medicine, Omuta City Hospital, 2-19-1 Takarazaka-machi, Omuta, Fukuoka, 836-8567, Japan.
Department of Cardiovascular Medicine, New Tokyo Hospital, Matsudo, Japan.
Cardiovasc Interv Ther. 2021 Apr;36(2):178-189. doi: 10.1007/s12928-020-00751-6. Epub 2021 Jan 11.
Percutaneous coronary intervention (PCI) for complex lesions is still technically demanding and is associated with less favorable procedural parameters such as lower success rate, longer procedural time, higher contrast volume and unexpected complications. Because the conventional angiographic analysis is limited by the inability to visualize the plaque information and the occluded segment, cardiac computed tomography has evolved as an adjunct to invasive angiography to better characterize coronary lesions to improve success rates of PCI. Adding to routine image reconstructions by coronary computed tomography angiography, the thin-slab maximum intensity projection method, which is a handy reconstruction technique on an ordinary workstation, could provide easy-to-understand images to reveal the anatomical characteristics and the lumen and plaque information simultaneously, and then assist to build an in-depth strategy for PCI. Especially in the treatment of chronic total occlusion lesion, these informations have big advantages in the visualization of the morphologies of entry and exit, the occluded segment and the distribution of calcium compared to invasive coronary angiography. Despite of the additional radiation exposure, contrast use and cost for cardiac computed tomography, the precise analysis of lesion characteristics would consequently improve the procedural success and prevent the complication in complex PCI.
经皮冠状动脉介入治疗（PCI）治疗复杂病变仍然具有较高的技术要求，并且与较差的手术参数相关，如成功率较低、手术时间较长、造影剂用量较高和意外并发症。由于传统的血管造影分析受到无法可视化斑块信息和闭塞段的限制，心脏计算机断层扫描已作为侵入性血管造影术的辅助手段，以更好地对冠状动脉病变进行特征描述，从而提高 PCI 的成功率。除了冠状动脉计算机断层血管造影的常规图像重建外，薄层最大密度投影法是普通工作站上一种便捷的重建技术，可以提供易于理解的图像，同时显示解剖特征、管腔和斑块信息，然后帮助制定深入的 PCI 策略。特别是在治疗慢性完全闭塞病变时，与侵入性冠状动脉造影相比，这些信息在显示入口和出口、闭塞段以及钙分布的形态方面具有很大优势。尽管心脏计算机断层扫描会增加额外的辐射暴露、造影剂使用和成本，但对病变特征的精确分析将提高复杂 PCI 的手术成功率并预防并发症。
