Discrepancy in Diagnosing Coronary Artery Occluded Lesion: CT-Derived Fractional Flow Reserve (FFRCT) Versus Invasive Coronary Angiography.

T. Tsugu, Kaoru Tanaka, Y. Nagatomo, M. De Maeseneer, J. De Mey
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Abstract

Coronary computed tomography angiography (CCTA) and CT-derived fractional flow reserve (FFRCT) findings demonstrate high diagnostic accuracy, aligning consistently with invasive coronary angiography (ICA), the gold standard diagnostic technique for coronary artery disease. The differential diagnosis of total versus subtotal coronary occlusion is crucial in determining the appropriate treatment strategy. Subtotal coronary occlusions composed of vulnerable tissue can sometimes present as total coronary occlusions on ICA. This presentation can be inconsistent with findings from CCTA and FFRCT. This case report presents discrepant findings between CCTA, which indicated subtotal coronary occlusion, and ICA, which suggested total coronary occlusion. The stenotic lesion, filled with vulnerable tissue (low-attenuation plaque volume: 20.3 mm3 and intermediate-attenuation plaque volume: 71.6 mm3), could be dilated with a vasodilator during maximal hyperemia. This dilation facilitated the acquisition of CCTA and FFRCT images. We were able to diagnose subtotal coronary occlusion and identify the overall anatomical structure of the vessels prior to percutaneous coronary intervention (PCI). This allowed us to perform a successful and uncomplicated PCI.
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诊断冠状动脉闭塞病变的差异:CT 导出的分数血流储备 (FFRCT) 与侵入性冠状动脉造影的比较。
冠状动脉计算机断层扫描血管造影术(CCTA)和计算机断层扫描衍生的分数血流储备(FFRCT)结果显示出很高的诊断准确性,与冠状动脉疾病的金标准诊断技术--有创冠状动脉造影术(ICA)一致。冠状动脉全闭塞与次全闭塞的鉴别诊断对于确定适当的治疗策略至关重要。由脆弱组织构成的冠状动脉次全闭塞有时会在 ICA 上表现为冠状动脉全闭塞。这种表现可能与 CCTA 和 FFRCT 的结果不一致。本病例报告中,CCTA 显示冠状动脉次全闭塞,而 ICA 显示冠状动脉全闭塞,两者的结果不一致。狭窄的病变部位充满了易损组织(低衰减斑块体积:20.3 立方毫米,中衰减斑块体积:71.6 立方毫米),可以在最大充血时用血管扩张剂进行扩张。这种扩张有助于获取 CCTA 和 FFRCT 图像。在进行经皮冠状动脉介入治疗(PCI)之前,我们能够诊断冠状动脉次全闭塞并确定血管的整体解剖结构。这使我们能够成功地进行不复杂的 PCI。
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