冠状动脉完全闭塞时远侧血管显影与侧支循环的关系——冠状动脉CTA与介入冠状动脉造影对照研究

The Relationship between Distal Vascular Imaging and Collateral Circulation in Total Coronary Artery Occlusion—A Comparative Study of Coronary CTA and Interventional Coro-nary Angiography

摘要: 目的：利用双源CT冠状动脉血管成像(DS-CTA)评估冠状动脉完全闭塞远侧血管显影及侧支循环并与介入冠状动脉造影(CAG)对照。方法：选取2019年1月~2021年3月于我院行冠状动脉双源CTA检查且在近一个月内行冠状动脉CAG检查的72位患者，共80处闭塞。以CAG为金标准，评估DS-CTA对冠状动脉闭塞远侧血管显影与侧支循环的显示率。结果：CAG检查的80处闭塞远端血管显影37处，显示闭塞周围有侧支循环者29处；相应患者DS-CTA显示有远端血管显影42处，周围有侧支循环者27处。CAG及DS-CTA两种方法显示闭塞远侧血管显影例数均多于侧枝循环显影(p > 0.05，差异无统计学意义)。DS-CTA对闭塞远端血管显影率略高于CAG (CAG远端血管显示率为46.25%，DS-CTA远端血管显示率为52.5%)，CAG显示闭塞远端侧支循环略高于DS-CTA (CAG显示闭塞远端侧支循环显示率为36.25%，DS-CTA显示侧支循环显示率约33.75%)，差异无统计学差异(p > 0.05，差异无统计学意义)。结论：以DS-CTA判断冠状动脉血管闭塞远侧血管显影及侧支循环形成有较高价值，特别是观测闭塞远侧血管显影间接推测侧支循环形成更加敏感。

Abstract: Objective: To use dual-source CT coronary angiography (DS-CTA) to evaluate the distal vascular im-aging and collateral circulation of total coronary occlusion and to compare it with interventional coronary angiography (CAG). Methods: From January 2019 to March 2021, 72 patients who under-went coronary dual-source CTA examination in our hospital and underwent coronary CAG examina-tion within the past month were selected, with a total of 80 occlusions. Using CAG as the gold stand-ard, DS-CTA was used to evaluate the visualization rate of vessels distal to coronary occlusion and collateral circulation. Results: CAG examination showed 37 of 80 occluded distal vessels, and 29 of them had collateral circulation around the occlusion; DS-CTA of the corresponding patients showed that 42 of the distal vessels were visualized, and 27 of them had collateral circulation around. The two methods of CAG and DS-CTA showed that the number of occlusion distal vessels was more than that of collateral circulation (p > 0.05, the difference was not statistically significant). The imaging rate of DS-CTA for distal occlusion vessels is slightly higher than that of CAG (46.25% for CAG distal vessels, 52.5% for DS-CTA), and CAG shows slightly higher collateral circulation distal to occlusion than DS-CTA (CAG showed the display rate of occluded distal collateral circulation was 36.25%, DS-CTA showed that the display rate of collateral circulation was about 33.75%), the difference was not statistically significant (p > 0.05, the difference was not statistically significant). Conclusion: DS-CTA is of high value in judging the development of vessels distal to coronary occlusion and the formation of collateral circulation, especially the observation of distal vessels of occlusion is more sensitive to indirectly infer the formation of collateral circulation.