الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Coronary artery disease is the most common cause of hospitalization and premature mortality in the industrial countries, acute coronary syndrome (ACS) and sudden cardiac death are frequently the first clinical manifestation of coronary artery disease. Plaque rupture is the principal cause of luminal thrombosis in acute coronary syndromes. Plaque vulnerability was defined as the susceptibility of a plaque to rupture, thus causing a clinical cardiovascular event (e.g., acute myocardial infarction or sudden cardiac death). The introduction of this concept paralleled an increased appreciation of the limitations of imaging arterial lumens and quantifying risk based merely on the severity of arterial stenosis. If vulnerable plaques can be detected accurately, and effective therapeutic interventions initiated before cardiovascular events occur, all in a cost-effective manner, then many (perhaps the majority) of cardiovascular events can, in theory, be prevented
MDCT is a rapidly evolving imaging tool that allows the noninvasive visualization of coronary atherosclerosis, MDCT is not only able to identify coronary artery stenosis, but also has the potential to provide information about lesion morphology and plaque composition identifying the vulnerable plaques adding a prognostic value in addition to the diagnostic value of MDCT.
Comparisons of MDCT with IVUS as a gold standard modality for the characterization of plaque morphology have shown an excellent agreement for the identification of plaque composition by MDCT.
Contemporary management of coronary artery disease relies increasingly on percutaneous techniques combined with medical therapy. The catheter-based treatment of coronary artery disease (CAD) has advanced substantially over the past 40 years and is currently a safe, reliable and effective therapeutic option for the millions of patients with CAD worldwide.
The aim of our study was to determine the predictive value of coronary plaque characterization as detected by 64- slice multi-detector Computed tomography in prediction of the procedural complexity of elective percutaneous coronary non CTO intervention.
The study was conducted retrospectively on forty five patients attempted for percutaneous coronary intervention (PCI) within six months of pre-procedural CCTA. The CCTA was analyzed in terms of calcium scoring, plaque type, length, volume, density, area and anatomical definition (site, side branch involvement, morphological type and degree of stenosis). Complex PCI was defined as use of buddy wire, kissing balloon, necessity of high-pressure balloon pre- or post-dilatation, use of anchor technique, or use of rotablator due to calcifications.
In the 45 patients; the mean age was 59.73 ± 9.93 years, 37 were males (82.2%) and 8 were females (17.8%), 24 were diabetic (53.3%), 36 were hypertensive (80%), 28 were having dyslipedemia (62.2%), 21 were smokers (46.7%) and 5 had family history of CAD (11.1%).
A total of 60 plaques attempted during PCI were distributed as 3 (5%) in LMCA, 25 (41.7%) in LAD, 6 (10%) in CX, 16 (26.7%) in RCA, 9 (15%) in diagonal branch, 8 (13.3%) in obtuse marginal branch and 3 (5%) in venous graft.
As regard side branch involvement; 11 plaques (18.3%) were bifurcating lesions. No trifurcating lesions were encountered during our study.
As regard lesion morphology; 16 (26.7%) were of type B morphology while the remaining 44 (73.3%) were of type C morphology.
As regard degree of stenosis, with the exclusion of totally occluded lesions, it ranged from 50% to 99% stenosis.
Calcium score of the attempted lesions showed a wide range calcium content ranging from no calcium content (calcium score = zero) to heavily calcific plaques (calcium score = 1555).
As regard plaque composition; 19 (31.7%) of the plaques were soft while 13 (21.7%) were of calcific type. The remaining 28 (46.6%) were mixed plaques.
Further assessment of the plaques; as regard plaque length, in the complex procedures it ranged from 8.30 mm to 96.70 with a mean of 34.92 mm while for non complex ones it ranged from 11.90 to 61.40 mm with a mean of 27.35 mm.
As regard Plaque volume; in the complex procedures it ranged from 92.0 to 1229.0 mm3 with a mean of 475.07 mm3 and in the non complex ones, it ranged from 69.0 to 824.0 mm3 with a mean of 270.24 mm3.
As regard Plaque density; in the complex procedures it ranged from 48.0 to 1159.0 HU with a mean of 371.85 HU while in the non complex ones, it ranged from 52.0 to 1307.0 HU with a mean of 232.29 HU.
As regard plaque area; in the complex procedures it ranged from 4.50 to 91.60 mm2 with a mean of 19.40 mm2 while in the non complex ones, it ranged from 2.80 to 32.0 mm2 with a mean of 11.24 mm2.
Our study showed that calcific plaques, local plaque volume, density and area are predictors of complexity of PCI procedure. While bifurcating plaques, lesion morphology, degree of stenosis and plaque length did not show statistically significant correlation with PCI complexity.
In our study, different techniques were used to treat complex lesions as following: Rota ablator was used in 2 lesions (4.7%), balloon pre-dilatation was used in 20 lesions (45.5%), balloon post-dilatation was used in 30 lesions (69.8%), anchor technique was used in 1 lesion (2.3%), buddy wire was used in 1 lesion (2.3%) and kissing balloon was used in 3 lesions (7%).
Also procedure related complications were encountered during our study in 11.7% of the attempted lesions (7 plaques). Coronary dissection was encountered in 4 plaques (6.7%), plaque shift was encountered in 3 plaques (5.0%) and no reflow phenomenon was encountered in 1 plaque (1.7%).