RESUMEN
BACKGROUND: Coronary computed tomography angiography (CCTA) provides information regarding lesion morphology and three-dimensional coronary anatomy incremental to coronary angiography. We addressed the question whether preprocedural CCTA bears potential for guiding percutaneous coronary interventions (PCI). METHODS AND RESULTS: Sixty-six coronary lesions attempted with PCI within 6 months of preprocedural CCTA were retrospectively assessed. Lesion parameters from unenhanced computed tomography (CT) for calcium scoring and CCTA were analyzed and compared with PCI complexity. Complex PCI was defined as use of buddy wire, kissing balloon, necessity of high pressure balloons, or rotablator. Complex PCIs were observed in 32 interventions (48%). Median Agatston score and Hounsfield units were higher in lesions with complex as compared to those with non-complex interventions with 130 (interquartile range, 23-276) vs 29 (0-158; P=.01), and 493 (245-631) vs 341 (68-520 Hounsfield Units; P=.04), respectively. Median local plaque volume and plaque mass were higher in complex PCI with 17 (2-39) vs 5 (0-19.5 mm³; P=.007), and 48 (15-99) vs. 16 (1.5-63 mg hydroxyapatite/mm³; P=.03), respectively. Lesions leading to complex PCI were longer [1.8 (1.2-2.8) vs 1.3 (0.8-1.7) cm; P=.03], and had a higher rate of calcified plaques (23% vs 3%; P=.03). There was a significant correlation between CCTA- and angiography-derived local SYNTAX Scores (P<.001); the CCTA-derived score seems to be predictive for failed and complex PCI (area under curve = 0.75 ± 0.13 and 0.66 ± 0.08, respectively). CONCLUSIONS: Preprocedural lesion assessment by CCTA indicates complexity of PCI. In patients with suspected complex coronary anatomy, prior CCTA adds important information for planning PCI.
Asunto(s)
Angioplastia Coronaria con Balón/métodos , Angiografía Coronaria/métodos , Enfermedad Coronaria/terapia , Tomografía Computarizada por Rayos X/métodos , Anciano , Calcinosis/diagnóstico por imagen , Estenosis Coronaria/diagnóstico por imagen , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador/métodos , Masculino , Persona de Mediana Edad , Placa Aterosclerótica/diagnóstico por imagen , Placa Aterosclerótica/patología , Placa Aterosclerótica/terapia , Curva ROC , Intensificación de Imagen Radiográfica , Radiografía Intervencional/métodos , Estudios RetrospectivosAsunto(s)
Infarto del Miocardio/diagnóstico , Infarto del Miocardio/terapia , Síndrome Coronario Agudo/clasificación , Síndrome Coronario Agudo/diagnóstico , Síndrome Coronario Agudo/terapia , Algoritmos , Angina Inestable/clasificación , Angina Inestable/diagnóstico , Angina Inestable/terapia , Anticoagulantes/administración & dosificación , Atorvastatina , Análisis Químico de la Sangre , Dolor en el Pecho/etiología , Clopidogrel , Angiografía Coronaria , Quimioterapia Combinada , Educación Médica Continua , Electroencefalografía , Medicina Familiar y Comunitaria/educación , Heparina/administración & dosificación , Ácidos Heptanoicos/administración & dosificación , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/administración & dosificación , Masculino , Persona de Mediana Edad , Infarto del Miocardio/clasificación , Inhibidores de Agregación Plaquetaria/administración & dosificación , Pronóstico , Pirroles/administración & dosificación , Factores de Riesgo , Suiza , Ticlopidina/administración & dosificación , Ticlopidina/análogos & derivadosRESUMEN
Cavernous malformations (CCMs) are benign, well-circumscribed, and mulberry-like vascular malformations that may be found in the central nervous system in up to 0.5% of the population. Cavernous malformations can be sporadic or inherited. The common symptoms are epilepsy, hemorrhages, focal neurological deficits, and headaches. However, CCMs are often asymptomatic. The familiar form is associated with three gene loci, namely 7q21-q22 (CCM1), 7p13-p15 (CCM2), and 3q25.2-q27 (CCM3) and is inherited as an autosomal dominant trait with incomplete penetrance. The CCM genes are identified as Krit 1 (CCM1), MGC4607 (CCM2), and PDCD10 (CCM3). Here, we present the clinical and genetic features of CCMs in 19 Swiss families. Furthermore, surgical aspects in such families are also discussed.