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. 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). FAI<sub>lesion</sub> 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 FAI<sub>RCA</sub> between the two groups [-77.4 (-81.9 to -75.6) vs. -78.5 (-86.0 to -71.0), p = 0.41].</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":94071,"journal":{"name":"Journal of cardiovascular computed tomography","volume":" ","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Specific calcium deposition on pre-procedural CCTA at the time of percutaneous coronary intervention predicts in-stent restenosis in symptomatic patients.\",\"authors\":\"Rafael Adolf, Insa Krinke, Janina Datz, Salvatore Cassese, Adnan Kastrati, Michael Joner, Heribert Schunkert, Wolfgang Wall, Martin Hadamitzky, Leif-Christopher Engel\",\"doi\":\"10.1016/j.jcct.2024.09.010\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>To characterize preprocedural coronary atherosclerotic lesions derived from CCTA and assess their association with in-stent restenosis (ISR) after percutaneous coronary intervention (PCI).</p><p><strong>Materials and methods: </strong>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.</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. 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). FAI<sub>lesion</sub> 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 FAI<sub>RCA</sub> between the two groups [-77.4 (-81.9 to -75.6) vs. -78.5 (-86.0 to -71.0), p = 0.41].</p><p><strong>Conclusion: </strong>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.</p>\",\"PeriodicalId\":94071,\"journal\":{\"name\":\"Journal of cardiovascular computed tomography\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-10-20\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of cardiovascular computed tomography\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1016/j.jcct.2024.09.010\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of cardiovascular computed tomography","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1016/j.jcct.2024.09.010","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
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。
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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