Correlation and assessment of coronary artery luminal stenosis: Post-mortem computed tomography angiogram versus histopathology

Background: The coronary computed tomography angiography features of acute spontaneous coronary artery dissection, an important cause of acute coronary syndrome in young women, have not been assessed. Methods: The “Virtual” Multicenter Mayo Clinic Spontaneous Coronary Artery Dissection Registry was established in 2010 and includes retrospective and prospective patient data. Retrospective assessment of acute coronary computed tomography angiography images was performed for 14 patients (16 vessels) who had images performed within two days of invasive coronary angiography diagnosis of acute spontaneous coronary artery dissection. Results: Four pertinent diagnostic coronary features of acute spontaneous coronary artery dissection were observed in order of prevalence: 1) abrupt luminal stenosis (64%); 2) intramural hematoma (50%); 3) tapered luminal stenosis (36%); and 4) dissection (14%). Additional findings include epicardial fat stranding (42%), coronary tortuosity (29%), and coronary bridge (14%). Fifty percent of patients had myocardial hypoperfusion in the myocardial distribution of the dissected coronary artery. Conclusions: We define key coronary computed tomography angiography features of acute spontaneous coronary artery dissection, the most common of which are abrupt luminal stenosis and intramural hematoma. Importantly, intramural hematoma appears similar to noncalcified atherosclerotic plaque, emphasizing the importance of invasive coronary angiography for acute diagnosis of spontaneous coronary artery dissection until the sensitivity and specificity of coronary computed tomography angiography is better understood.

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Abstract 5813: Vascular Function Measured By Digital Thermal Monitoring Strongly Correlates with the Severity of Coronary Artery Disease Diagnosed by 64 Slice Multidetector Computed Tomography

Circulation ◽

10.1161/circ.118.suppl_18.s_108-c ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Naser Ahmadi ◽

Vivek Nuguri ◽

Sumithra Tirunagaram ◽

Anila Saeed ◽

Fereshteh Hajsadeghi ◽

...

Keyword(s):

Risk Factors ◽

Computed Tomography ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Multidetector Computed Tomography ◽

Vascular Function ◽

List Type ◽

Thermal Monitoring ◽

Luminal Stenosis ◽

Artery Disease

Background: Digital Thermal Monitoring (DTM) of vascular reactivity is a new test of vascular function that correlates well with the Framingham Risk Score and subclinical coronary artery disease measured by the coronary calcium score. This study evaluates whether DTM correlates with the severity of coronary artery disease (CAD) measured by 64 slice multidetector computed tomography (MDCT). Methods: 151 patients, mean age 64±9 years, 69% male, were studied. Each underwent DTM during a 5 minute supra systolic arm-cuff occlusion and MDCT. Post-cuff deflation fingertip temperature rebound (TR) was correlated with CAD severity assessed by MDCT. Results: After adjusting for age, gender and CAD risk factors using logistic regression analysis, the odds ratio for TR in the lowest tertile vs. upper 2 tertiles was 1.3 (95% CI 0.89 –1.6, p=0.4) for mild CAC (luminal stenosis<30%), 2.7 (95% CI 1.2–3.9, p=0.0001) for moderate CAD (30 –70% luminal stenosis) and 6.94 (95% CI 2.2–10.7, p=0.0001) for severe CAD (luminal stenosis>70%) compared to normal coronaries. Additionally, TR was lower in coronary segments with mixed plaque compared to calcified plaque (0.43±0.17 vs. 0.91±0.19, p=0.001). Conclusions: Vascular dysfunction measured by DTM strongly correlates with the severity and characteristics of coronary plaques measured by MDCT, independent of age, gender and cardiac risk factors. DTM may be a useful tool for the identification of high risk patients, additional studies are warranted.

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Screening coronary artery disease with computed tomography angiogram should limit normal invasive coronary angiogram, regardless of pretest probability

American Heart Journal ◽

10.1016/j.ahj.2019.12.023 ◽

2020 ◽

Vol 223 ◽

pp. 113-119 ◽

Cited By ~ 1

Author(s):

Sonia Houssany-Pissot ◽

Julien Rosencher ◽

Philippe Allouch ◽

Christophe Bensouda ◽

Remy Pillière ◽

...

Keyword(s):

Computed Tomography ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Pretest Probability ◽

Coronary Angiogram ◽

Computed Tomography Angiogram ◽

Artery Disease

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16.20Improved Coronary Artery Imaging with 64-Slice Computed Tomography Angiogram: A Meta-Analysis

Journal of Nuclear Cardiology ◽

10.1016/j.nuclcard.2007.06.034 ◽

2007 ◽

Vol 14 (4) ◽

pp. S111-S112 ◽

Cited By ~ 1

Author(s):

T BRAHMBHATT

Keyword(s):

Computed Tomography ◽

Coronary Artery ◽

Meta Analysis ◽

Coronary Artery Imaging ◽

Computed Tomography Angiogram

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A Novel Approach Using Computed Tomography Angiograms to Predict Sternotomy Or Complicated Anastomosis in Patients Undergoing Robotically Assisted Minimally Invasive Direct Coronary Artery Bypass

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000499 ◽

2018 ◽

Vol 13 (3) ◽

pp. 207-210

Author(s):

Richard C. Cook ◽

Anthony Y. Fung ◽

Edward D. Percy ◽

John R. Mayo

Keyword(s):

Computed Tomography ◽

Coronary Artery ◽

Relative Risk ◽

Minimally Invasive ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Entire Group ◽

Left Anterior Descending Artery ◽

Novel Approach ◽

Computed Tomography Angiogram

Objective Robotically assisted minimally invasive direct coronary artery bypass is an alternative to sternotomy-based surgery in properly selected patients. Identifying the left anterior descending artery when it is deep in the epicardial fat can be particularly challenging through a 5- to 6-cm mini-thoracotomy incision. The objective of this study was to evaluate a technique for predicting conversion to sternotomy or complicated left anterior descending artery anastomosis using preoperative cardiac-gated computed tomography angiograms. Methods Retrospective review of 75 patients who underwent robotically assisted minimally invasive direct coronary artery bypass for whom a preoperative computed tomography angiogram was available. The distance from the left anterior descending artery to the myocardium was measured on a standardized “5-chamber” axial computed tomography view. The relative risk of sternotomy or complicated anastomosis was compared between patients whose left anterior descending artery was resting directly on the myocardium (left anterior descending artery to the myocardium distance = 0 mm) with those whose left anterior descending artery was resting above (left anterior descending artery to the myocardium distance > 0 mm). Results The average left anterior descending artery to the myocardium distance was 3.2 ± 2.6 mm (range = 0–11.5 mm). Fourteen patients (18.7%) had an left anterior descending artery to the myocardium distance of 0 mm. Of the entire group of 75 patients, 6 (8.0%) required conversion to sternotomy. Four others (5.3%) were reported to have a complication with the anastomosis intraoperatively. For patients with left anterior descending artery to the myocardium distance of 0 mm, the relative risk of sternotomy or complicated anastomosis was 18.0 (95% confidence interval = 4.3–75.6, P = 0.0001). Conclusions In our experience, patients with left anterior descending artery to the myocardium distance of 0 mm were at significantly higher risk of either conversion to sternotomy or technically challenging anastomosis, with 8 (57.1%) of 14 patients in this group experiencing either end point. This novel measurement may be useful to identify patients who may have anatomy, which is not well suited to the robotically assisted minimally invasive direct coronary artery bypass approach.

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