الفهرس 
CURRENT DIRECTIONS AND FUTURE PROSPECTIVES IN CCTAOnly 14 pages are availabe for public view
 |  | from | 162 |  |  |
| | | from | 162 | | |
Abstract
I
nvasive coronary angiography has been traditionally used for evaluation of the presence and severity of coronary artery disease. Accordingly, the technique has been extensively utilized to guide further treatment strategies, such as percutaneous coronary intervention with stent placement. PCI is the most common revascularization strategy for patients with symptomatic obstructive coronary artery disease. Procedural success is dependent on the accurate assessment of the target lesion and accurate stent selection.
Coronary computed tomographic angiography (CCTA) is an emerging noninvasive imaging modality with good sensitivity and specificity for detecting obstructive CAD and plaque characteristics. Given its ability to assess coronary anatomy as well as nearby coronary plaque, it may have the ability to provide additional information to assist with stent selection. Accurate sizing of stents used during PCI is essential to avoid the instent restenosis and late stent thrombosis
This study was done to assess the impact of incorporating CCTA guidance in defining reference value for stent length and diameter on angiographic and clinical outcomes in comparison to quantitative coronary angiography and its effect on incidence of instent restenosis. The study was conducted on 153 diabetic patients with stable coronary artery disease presented to cardiac catheterization laboratory at National Heart Institute and Sheikh Zayed Specialized Hospital in the period from December 2013 to June 2016. Patients were divided into two groups: group A and group B according to PCI guidance either with QCTA datasets or QCA datasets respectively.
All patients were subjected to full history taking, clinical examination, twelve lead surface ECG, serum urea and creatinine, lipid profile, PCI guided by QCTA or QCA according to patient group, follow up clinically for six months to assess incidence of MACE and angiographically by coronary angiography at six months or before if clinically indicated to assess incidence of instent restenosis (primary end point).
QCTA and QCA data were compared to each other in group A. Baseline clinical variables, angiographic data, PCI procedural data, follow up clinical and angiographic outcomes in group A and group B were compared to each other.
QCTA was associated with longer lesions and larger reference vessel diameter than that measured by invasive QCA in group A. No statistical significant difference between group A and group B regarding restenosis rate, minimum lumen diameter at follow up and incidence of MACE.
CCTA guided PCI is a safe and effective strategy for treatment of coronary artery disease however it didn’t add a beneficial role in reducing incidence of instent restenosis or MACE in comparison to angiographic guidance alone.
Multicenter follow-up studies focused on clinical and angiographic outcomes of CCTA-based stent sizing, with a larger number of PCI operators representing greater variety of stenting practice should be performed to confirm the clinical usefulness of this strategy as well as determining correlation of CCTA with intravascular ultrasound.