Mohamed Mohamed Saber, Mostafa Mansour Mohamed, Abdelfattah Ashraf Alamir
Cardiovascular Medicine Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Postepy Kardiol Interwencyjnej. 2023 Jun;19(2):135-141. doi: 10.5114/aic.2023.129212. Epub 2023 Jun 30.
Coronary computed tomographic angiography (CCTA) is a highly diagnostically accurate non-invasive imaging method for a thorough evaluation of atherosclerotic plaques. Many CCTA-based imaging investigations concentrate on bifurcation lesions.
To determine whether intraprocedural side branch (SB) obstruction during the percutaneous coronary intervention (PCI) of lesions involving bifurcations might be predicted by preprocedural CCTA.
This retrospective observational study was conducted on 200 stentable bifurcation lesions of 200 coronary artery disease patients with the SB ≥ 2 mm in diameter. All patients were planned for elective bifurcation PCI after undergoing CCTA for quantitative plaque characterization of both the main vessel and SB to obtain the CT bifurcation score. Then, angiography-based bifurcations were classified using both the Medina classification and the RESOLVE score before PCI of the bifurcation lesions. Most of the cases were managed by the provisional technique.
The CT bifurcation score was substantially higher in patients with SB occlusion ( < 0.001) with 80% sensitivity and 60% specificity at a cut-off point of 3. There was a borderline significant relation between the Medina score and SB occlusion in the studied cases ( = 0.05) with 60% sensitivity and 40% specificity. The RESOLVE score was unexpectedly an insignificant predictor of SB occlusion ( = 0.25) in our study, with 40% sensitivity and 50% specificity.
Intraprocedural SB occlusion can be predicted by a comprehensive CCTA evaluation. The CT bifurcation score, a novel and simple points scoring system based on six CCTA parameters, outperformed current angiographic classification or scoring systems for predicting SB occlusion.
冠状动脉计算机断层血管造影（CCTA）是一种诊断准确性高的非侵入性成像方法，用于全面评估动脉粥样硬化斑块。许多基于CCTA的成像研究都集中在分叉病变上。
确定在涉及分叉病变的经皮冠状动脉介入治疗（PCI）过程中，术前CCTA是否可以预测术中边支（SB）阻塞。
本回顾性观察性研究对200例直径≥2mm边支的冠心病患者的200个可植入支架的分叉病变进行。所有患者在接受CCTA以对主血管和边支进行定量斑块特征分析以获得CT分叉评分后，计划进行择期分叉PCI。然后，在分叉病变PCI术前，使用Medina分类和RESOLVE评分对基于血管造影的分叉进行分类。大多数病例采用临时技术处理。
边支闭塞患者的CT分叉评分显著更高（<0.001），在截断点为3时，敏感性为80%，特异性为60%。在研究病例中，Medina评分与边支闭塞之间存在临界显著关系（=0.05），敏感性为60%，特异性为40%。在我们的研究中，RESOLVE评分意外地不是边支闭塞的显著预测指标（=0.25），敏感性为40%，特异性为50%。
通过全面的CCTA评估可以预测术中边支闭塞。CT分叉评分是一种基于六个CCTA参数的新颖且简单的评分系统，在预测边支闭塞方面优于当前的血管造影分类或评分系统。
