Interventional Radiology Unit, Department of Medical Imaging, University Hospital of Heraklion, Crete, Greece; Department of Radiology, School of Medicine, University of Crete, Voutes Campus, Heraklion, Greece.
Interventional Radiology Unit, Department of Medical Imaging, University Hospital of Heraklion, Crete, Greece.
Eur J Radiol. 2024 Jul;176:111539. doi: 10.1016/j.ejrad.2024.111539. Epub 2024 May 29.
To investigate whether Dual-Energy Computed Tomography (DECT) could be useful in the lesion characterization and endovascular treatment planning of symptomatic patients with peripheral arterial disease (PAD) due to Chronic Total Occlusions (CTO).
Between 2018 and 2022, 60 symptomatic patients (52 male, age 71 years) with peripheral arterial CTO underwent DECT angiography before percutaneous endovascular treatment. Patients were classified, according to guidewire crossing difficulty into four categories, which were subsequently correlated with DECT values, including Dual Energy Index (DEI) and Effective Z (Zeff). DECT values were also corelated with crossing time. The crossing difficulty was further correlated with the Trans-Atlantic Inter-Society Consensus Document (TASC II) classification.
Technical success, defined as perceived antegrade true lumen or subintimal crossing, was achieved in 76.7 %. Among the cases, 20 were deemed easy, 14 moderate, 12 hard and 14 were failed attempts. Statistical analysis revealed a significant correlation between DEI, Zeff values, and the crossing difficulty categories (p < 0.001). Additionally, there was also a correlation between crossing time and DECT values. However, no significant correlation was recorded between difficulty categories and TASC II classification.
Pre-procedural DECT angiography provides valuable information for patient selection and planning of the revascularization strategy. Moreover, it is helpful in the selection of the appropriate PTA materials, based on the lesion characteristics. Further research should be invested in this important field, to determine the optimal treatment approach in patients suffering from PAD due to CTOs.
探讨双能 CT（DECT）在有症状的慢性完全闭塞（CTO）外周动脉疾病（PAD）患者的病变特征和血管内治疗计划中的作用。
2018 年至 2022 年，60 例有症状的 CTO 外周动脉患者（52 例男性，71 岁）在经皮腔内血管成形术前行 DECT 血管造影。根据导丝穿越的难易程度将患者分为 4 类，然后与 DECT 值（包括双能指数（DEI）和有效 Z 值（Zeff））进行相关性分析。还将 DECT 值与穿越时间进行相关性分析。穿越难度与跨大西洋介入学会共识文件（TASC II）分类进一步相关。
技术成功定义为可感知的顺行真腔或内膜下穿越，成功率为 76.7%。其中 20 例为简单、14 例为中度、12 例为困难和 14 例为失败。统计学分析显示 DEI、Zeff 值与穿越难度分类之间存在显著相关性（p<0.001）。此外，穿越时间与 DECT 值之间也存在相关性。然而，难度分类与 TASC II 分类之间无显著相关性。
术前 DECT 血管造影可为患者选择和血运重建策略的规划提供有价值的信息。此外，它有助于根据病变特征选择合适的 PTA 材料。应在这一重要领域进行进一步研究，以确定 CTO 导致 PAD 患者的最佳治疗方法。
