经皮冠状动脉介入治疗时术前 CCTA 上的特异性钙沉积可预测无症状患者支架内再狭窄的发生。

Rafael Adolf, Insa Krinke, Janina Datz, Salvatore Cassese, Adnan Kastrati, Michael Joner, Heribert Schunkert, Wolfgang Wall, Martin Hadamitzky, Leif-Christopher Engel
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We performed a plaque analysis of culprit lesions on CCTA using a dedicated plaque analysis software including assessment of the surrounding pericoronary fat attenuation index (FAI) and compared findings between lesions with and without ISR at surveillance angiography after stenting.</p><p><strong>Results: </strong>Overall 278 coronary lesions in 209 patients were included. Of these lesions, 43 (15.5 ​%) had ISR at surveillance angiography after stenting while 235 (84.5 ​%) did not. Likewise, plaque composition such as volume of calcification [129.8 mm<sup>3</sup> (83.3-212.6) vs. 94.4 mm<sup>3</sup> (60.4-160.5) p ​= ​0.06] and lipid-rich and fibrous plaque volume [38.4 mm<sup>3</sup> (19.4-71.2) vs. 38.0 mm<sup>3</sup> (14.0-59.1), p ​= ​0.11 and 50.4 mm<sup>3</sup> (26.1-77.6) vs. 42.1 mm<sup>3</sup> (31.1-60.3), p ​= ​0.16] between lesion with and without ISR were not statistically significant. 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引用次数: 0

摘要

目的:描述从 CCTA 中得出的术前冠状动脉粥样硬化病变的特征,并评估它们与经皮冠状动脉介入治疗(PCI)后支架内再狭窄(ISR)的关联:这项回顾性队列研究纳入了因疑似冠状动脉疾病接受 CCTA 检查、随后接受包括 PCI 在内的指数血管造影术以及指数造影术后 6-8 个月内接受监测血管造影术的患者。我们使用专用斑块分析软件对 CCTA 上的罪魁祸首病变进行了斑块分析,包括评估周围冠状动脉周围脂肪衰减指数(FAI),并比较了支架植入术后监测血管造影时有 ISR 和无 ISR 病变的结果:共纳入了 209 名患者的 278 个冠状动脉病变。在这些病变中,43 例(15.5%)在支架植入术后的监测血管造影中发现有 ISR,235 例(84.5%)没有。同样,斑块的组成,如钙化体积[129.8 mm3 (83.3-212.6) vs. 94.4 mm3 (60.4-160.5) p = 0.06]和富含脂质和纤维斑块体积[38.4 mm3 (19. 4-71.2) vs. 94.4 mm3 (60.4-160.5) p = 0.06]。4-71.2) vs. 38.0 mm3 (14.0-59.1), p = 0.11 和 50.4 mm3 (26.1-77.6) vs. 42.1 mm3 (31.1-60.3), p = 0.16]均无统计学意义。然而,与 ISR 相关的病变更偏心(n = 37,86.0% 对 n = 159,67.7%;p = 0.03),在横截面数据集上,血管壁两侧的钙化部分更常见(n = 24,55.8% 对 n = 55,23.4%;p = 0.001)。与无 ISR 的病变相比,有 ISR 的病变的 FAIlesion 有明显差异 [-76.5 (-80.1 to -73.6) vs. -80.9 (-88.9 to -74.0),p = 0.02]。两组的FAIRCA没有差异[-77.4 (-81.9 to -75.6) vs. -78.5 (-86.0 to -71.0), p = 0.41]:结论:在监测血管造影时,与 ISR 相关的冠状动脉病变在钙化部分的排列上存在差异,并且在基线 CCTA 时病变特异性冠状动脉周围脂肪衰减指数增加。后一项发现表明,基线时的血管周围炎症可能在支架内再狭窄的发生中扮演重要角色。
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Specific calcium deposition on pre-procedural CCTA at the time of percutaneous coronary intervention predicts in-stent restenosis in symptomatic patients.

Purpose: To characterize preprocedural coronary atherosclerotic lesions derived from CCTA and assess their association with in-stent restenosis (ISR) after percutaneous coronary intervention (PCI).

Materials and methods: This retrospective cohort-study included patients who underwent CCTA for suspected coronary artery disease, subsequent index angiography including PCI and surveillance angiography within 6-8 months after the index procedure. We performed a plaque analysis of culprit lesions on CCTA using a dedicated plaque analysis software including assessment of the surrounding pericoronary fat attenuation index (FAI) and compared findings between lesions with and without ISR at surveillance angiography after stenting.

Results: Overall 278 coronary lesions in 209 patients were included. Of these lesions, 43 (15.5 ​%) had ISR at surveillance angiography after stenting while 235 (84.5 ​%) did not. Likewise, plaque composition such as volume of calcification [129.8 mm3 (83.3-212.6) vs. 94.4 mm3 (60.4-160.5) p ​= ​0.06] and lipid-rich and fibrous plaque volume [38.4 mm3 (19.4-71.2) vs. 38.0 mm3 (14.0-59.1), p ​= ​0.11 and 50.4 mm3 (26.1-77.6) vs. 42.1 mm3 (31.1-60.3), p ​= ​0.16] between lesion with and without ISR were not statistically significant. However lesions associated with ISR were more eccentric (n ​= ​37, 86.0 ​% versus n ​= ​159, 67,7 ​%; p ​= ​0.03) and more frequently demonstrated calcified portions on opposite sides on the vessel wall on cross-sectional datasets (n ​= ​24, 55.8 ​% versus n ​= ​55, 23.4 ​%, p ​= ​0.001). FAIlesion was significantly different in lesions with ISR as compared to those without ISR [-76.5 (-80.1 to -73.6) vs. -80.9 (-88.9 to -74.0), p ​= ​0.02]. There was no difference with respect to FAIRCA between the two groups [-77.4 (-81.9 to -75.6) vs. -78.5 (-86.0 to -71.0), p ​= ​0.41].

Conclusion: Coronary lesions associated with ISR at surveillance angiography demonstrated differences in the arrangement of calcified portions as well as an increased lesion-specific pericoronary fat attenuation index at baseline CCTA. This latter finding suggests that perivascular inflammation at baseline may play a major role in the development of in-stent restenosis.

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Diagnostic performance of CCTA and CTP imaging for clinically suspected in-stent restenosis: A meta-analysis. Cost-effectiveness of ultrahigh-resolution photon-counting detector coronary CT angiography for the evaluation of stable chest pain. Association of coronary inflammation with plaque vulnerability and fractional flow reserve in coronary artery disease. Prognostic value of left ventricular mass measured on coronary computed tomography angiography. Coronary computed tomography angiography for the diagnosis of significant left main coronary artery disease.
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