16:45 Martin - Non Invasive Imaging
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Transcript of 16:45 Martin - Non Invasive Imaging
Non-Invasive Imaging: Applying Findings During Your PCI
V Martin-Yuste MD, [email protected]
ITC. Hospital Clinic Barcelona. Spain
MDCT AND CTO: Which morphological parameters can
we analyze?
Stump morphology
Diameter of the patent vessel, distal vessel
Occlusion length
Tortuosity
Presence of side branches
Calcification
Diameter of the patent vessel
Distal vessel
Anterograde injection
Occlusion length measurement
Retrograde injection
Angiography
Occlusion length measurement
Occlusion length measurement
20 mm
Bending between CTO and patent vessel
Bending in CTO body
Distal vessel analysis and presence of side branch
Plaque composition/ calcium quantification
99 HU156 HU127 HU
Plaque composition/ calcium quantification
247 HU409 HU212 HU
What do we know about MDCT and CTO?
What do we know about MDCT AND CTO?
45 patients Predictor factors of PCI failure
Occlusion length > 15 mm Blunt stump Severe calcification (>130 HU affecting >50% wall vessel)
Multivariate analysis the only independent predictor of procedural success was the absence of severe calcification
Mollet et al Am J Cardiol. 2005;95(2):240-243.
What do we know about MDCT AND CTO? 110 CTO lesions Morphological parameters analyzed:
Target vessel bending Shrinkage Severe calcification (density of calcium >500 HU affecting around 360º of
the wall vessel) Presence of side branches Stump morphology Occlusion length in-stent restenosis
Independent predictors of failure to cross the occlusion with the wire: Severe tortuosity: 57% vs 95%, p<0.0001 Shrinkage: 44% vs 88%, p=0.0005 Severe calcification: 71% vs 88%, p=0.0356
Ehara et al . J Invasive Cardiol 2009, 21: 575-582
What do we know about MDCT AND CTO? 64 patients 72 CTO , 64 slice MDCT Procedural success rate: 76%
Calcium parameters analyzed: Regional calcium volume Regional calcium score (calcified area x HU (1: 130-190; 2:
200-299;3: 300- 399;4 >400) Relative calcium area (% calcium area/vessel area) at the
most calcified cross section of CTO Regional calcium equivalent mass Total calcium score
Cho et al. Int J Cardiol 2010: 5;14581): 9-14
Cho et al. Int J Cardiol 2010: 5;14581): 9-14
What do we know about MDCT AND CTO?
We performed a MDCT in 69 patients with CTO Morphological parameters analyzed
Diameter of the proximal and distal patent vessel Occlusion length Bending Presence of side branches Stump morphology calcification
Martin et al. Rev Esp Cardiol. 2012 Apr;65(4):334-40.
Calcification Global calcium score
Calcium score of the occluded segment
Entry point Middle part Distal point
Distribution around the circumference of the
vessel (arc):
Martin et al. Rev Esp Cardiol. 2012 Apr;65(4):334-40.
Prox. Middle Distal
ARCCALCIUM
25% 100% 75%
HU 85 186 933
Martin et al. Rev Esp Cardiol. 2012 Apr;65(4):334-40.
N Global N=73 success (n=51) Failure (n=22) p
CTO length 68 22.6± 16.6(3-90)
22 ± 17.2 24 ± 15.5 0.46
Lesion length 66 44.2 ± 24.8(7-100)
42.5 ±(25.1 48.4± 24 0.39
Homocolaterals 72 13 (18.1%) 7(14%) 6 (27.3%) 0.2
Heterocolaterals 69 45 (65.2 %) 29 (60%) 16 (76%) 0.28
Entry point 62 0.56
Tapered 28 (45.2%) 19 (42.2%) 9 (53%)
Blunt 34 (54.8) 26 (57.8) 8 (47)
Diameter proximal vessel , mm
72 3.6 ± 0.8 3.5 ± 0.7 3.8± 0.9 0.2
Diameter distal vessel, mm
56 2.3± 0.5 2.32 ± 0.5 2.35 ± 0.3 0.4
Proximal branch 73 47 (64.4%) 33 (64.7%) 14 (63.6%) 0.9
Distal branch 70 41 (58.6%) 27 (56.3%) 14 (63.6%) 0.61
Global Calcium score
36 824± 796 743 ± 717 (n=27) 1040 ± 1013 (n=9) 0.47
Martin et al. Rev Esp Cardiol. 2012 Apr;65(4):334-40.
N Global N=73 Success (n=51)
Failure (n=22) p
HU entry point 69 219.5 ± 195 (50-1270) 194.6 ±146 280.5±278 0.1HU distal 68 152 ±102 (23-688) 156.1± 109 141 ± 83 0.67HU middle point 69 180.6± 133 (6-933) 186.6 ± 153 165.7± 64 0.63Arc Calcium prox. 66 0.048No 26 (39.4) 21 (47.7) 5 (22.7)<50% 30 (45.5) 18 (40.9) 12 (54.5)>50% 10 (15.2) 5 (11.4) 5 (22.7)Arc Calcium distal 66 0.95No 31 (47) 20 (45.5) 11 (50)<50% 26 (39.4) 19 (43.2) 7 (31.8)>50% 9 (13.6) 5 (11.4) 4 (18.2)Arc Calcium middle 66 0.037No 32 (48.5) 24 (54.5) 8 (36.4)
<50% 30 (45.5) 16 (36.4) 14 (63.6)
>50% 4 (6.1) 4 (9.1) 0
Martin et al. Rev Esp Cardiol. 2012 Apr;65(4):334-40.
Martin et al. Rev Esp Cardiol. 2012 Apr;65(4):334-40.
Conclusions
Calcification is the most important predictor of PCI failure
It is not possible to obtain a complete high quality study in all patients/lesions analyzed by MDCT
The anatomical information acquired is important but not determinant in a significant number of patients, so we can not recommend the routine use of this technique: Difficult cases To understand the cause of previously failed cases
In order to establish the correct indications a randomized study is needed