Schmermund A, Haude M, Baumgart D, Görge G, Grönemeyer D, Seibel R, Sehnert C, Erbel R
Department of Cardiology, University Clinic Essen, Germany.
Eur Heart J. 1996 Oct;17(10):1546-53. doi: 10.1093/oxfordjournals.eurheartj.a014719.
The aim of the study was the evaluation of electron beam computed tomography as a non-invasive method to localize coronary stents and to document patency in stented vessel segments.
Twenty-two patients (16m/6f, 58 +/- 7.8 years) with coronary Palmaz-Schatz stents were examined. Contrast enhanced electron beam computed tomography using an Evolution scanner (Siemens) and coronary angiography were carried out within 7 days of each other. Stent localization was performed using the single-slice mode of the electron beam computed tomography scanner. Patency of the coronary target segment was assessed using the multi-slice mode after peripheral venous injection of a 40 ml bolus of contrast medium (Ultravist 370). Qualitative image analysis of a cine loop of 10 consecutive frames and quantitative analysis of densitometric curves in a region of interest distal to the stented vessel segment were performed.
All stented vessel segments were identified. In 20 patients (91%), qualitative assessment of contrast enhancement patterns enabled stent patency to be evaluated. In 18 patients (90%), contrast medium was visualized distal to the stent. Quantitative coronary angiography confirmed that the stented vessel segments were not stenosed. Densitometric curves obtained in 16 of these 18 patients yielded contrast enhancement distal to the stented vessel segment of 63 +/- 6% compared to the aorta. In one patient, qualitative and quantitative analysis showed prolonged contrast enhancement of reduced density, which hinted at a stenosis related to the stented vessel segment. Coronary angiography revealed subtotal occlusion of the stented vessel directly distal to the stent. In another patient, no contrast visualization of the vessel distal to the stent was achieved. Coronary angiography revealed complete stent occlusion in this case.
Electron beam computed tomography can reliably localize coronary stents and may become a useful tool for providing information on stented vessel segment patency.
本研究的目的是评估电子束计算机断层扫描作为一种非侵入性方法用于定位冠状动脉支架并记录支架植入血管节段的通畅情况。
对22例植入冠状动脉Palmaz-Schatz支架的患者（16例男性/6例女性，年龄58±7.8岁）进行检查。使用Evolution扫描仪（西门子）进行对比增强电子束计算机断层扫描，并在彼此7天内进行冠状动脉造影。使用电子束计算机断层扫描扫描仪的单层模式进行支架定位。在经外周静脉注射40ml造影剂团注（优维显370）后，使用多层模式评估冠状动脉目标节段的通畅情况。对连续10帧的电影环进行定性图像分析，并对支架植入血管节段远端感兴趣区域的密度曲线进行定量分析。
所有支架植入血管节段均被识别。在20例患者（91%）中，通过对对比增强模式的定性评估能够评估支架的通畅情况。在18例患者（90%）中，在支架远端可见造影剂。定量冠状动脉造影证实支架植入血管节段无狭窄。在这18例患者中的16例获得的密度曲线显示，与主动脉相比，支架植入血管节段远端的对比增强为63±6%。在1例患者中，定性和定量分析显示对比增强延长且密度降低，提示与支架植入血管节段相关的狭窄。冠状动脉造影显示支架直接远端的植入血管节段次全闭塞。在另1例患者中，未实现支架远端血管的造影剂显影。冠状动脉造影显示该病例中支架完全闭塞。
电子束计算机断层扫描能够可靠地定位冠状动脉支架，并可能成为提供支架植入血管节段通畅信息的有用工具。
