多层螺旋CT指导下慢性闭塞病变的介入治疗

目的探讨多层螺旋CT(MDCT)对于慢性闭塞(CTO)病变PCI结果有无指导作用。方法选择在我院行冠状动脉MDCT证实为冠状动脉CTO,并在我院心内科行择期PCI的冠心病患者35例。根据CT图像判断CTO病变的位置、性质及钙化程度,闭塞血管远段血流分级以及闭塞近段管腔直径等指标是否对PCI结果及操作时间有预测及指导意义。结果 35例患者中有37支闭塞血管,其中21支(56.8%)获得再通,未再通血管中43.8%位于右冠状动脉,56.2%位于血管近段,钙化斑块占56.2%,80.0%的血管在CT图像上无法看到闭塞远段造影剂渗漏。TIMI血流(P=0.0128)及闭塞部位血管病变的性质(P=0.0703)是CTO病变再通的影响因素。闭塞血管所处节段(P=0.0157)以及闭塞血管所处位置(P=0.0704)是开通CTO病变操作时间的影响因素。结论MDCT可以准确判断CTO病变的走行,评价其斑块的性质及分布。闭塞病变远段有无血流及斑块的性质是PCI是否成功的预测因素。闭塞血管的不同以及所处节段的不同是PCI操作时间长短的预测因素。

MDCT-guided percutaneous coronary intervention of chronic total coronary artery occlusion

Objective To investigate whether multidetector spiral computed tomography (MDCT) can be used to guide percutaneous coronary intervention (PCI) of chronic total occlusion (CTO). Methods The study included the patients who were diagnosed as CTO by MDCT from may 2007 to Feb. 2008 in Chinese PLA General Hospital. All patient's MDCT images were analyzed for location, segment, plaque characteristics, calcification,TIMI-grade distal to CTO and lumen diameter proximal to CTO prior to PCI. Then PCI was performed and correlate with MDCT. The outcome of PCI and time of procedure were recorded. Results Thirty five patients and thirty seven lesions were included. Successful PCI was obtained in 21 CTOs(56.8%). Failure of recanalization occurred in right coronary artery(43.8%), proximal artery(56.2%), calcification plaque (56.2%) and TIMI-0 grade (80.0%). The following factors appeared to be the significantly independent factors influencing revascularization:TIMI-grade (P=0. 0128) and plaque characteristics (P=0.0703). The factors influencing time of PCI procedure: location (P=0.0704)and segment (P=0.0157) of CTO. Conclusion MDCT can accurately identify the run of the CTO segment and evaluate both distribution and characteristics of the plaque within it. The factors predicting successful PCI include TIMI-grade distal to the lesion and plaque characteristics. The factors predicting time of PCI procedure are location and segment of CTO. In a conclusion, MDCT, to some extent, can predict the chance of successful PCI in CTOs.