| Nowl/4 Populations in the global have been threatened by cardiovascular and related diseases, finally 1/5 of the population die of cardiovascular disease associated. According to the 2008 world health organization of the global burden of disease report, cardiovascular disease has become the primary cause of death to human being, and jumped to the first, accounted for 29% of the global total death, including7.2 million deaths annually dieing of coronary heart disease. The treatment method of coronary heart disease mainly include medication, percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG), etc. Currently coronary intervention is still one of the main treatment method of coronary heart disease, and presents the fast growth trend. Higher restenosis rate in the era of PTCA, bare metal stents and stent thrombosis of each period in the era of drug-eluting stents, etc. affected intervention treatment effect and widely used for coronary lesions. In addition to continuously improve DES technologies, such as research and develop on promoting endothelial healing stent and biodegradable stent, etc. to promote endothelial healing, prevent thrombosis, reduce restenosis, reduce reascularization rate, also paying attention to influence of the operating correlation factors to postoperative. Stent malapposition or inappropriate position, stent size not suitable can significantly increase drug stent thrombosis risk,reascularization rate and mortality. Studies on coronary angiography and provide more accurate information for PCI to reduce the influence factors of operation to postoperation is a hot and focus in the field of cardiology intervention in last few years.In clinical practice, interpretation of coronary angiography results basically have two kinds of methods, one is visual estimation according to intervention experts’ exPeriencethat is the most commonly used method, One is two-dimensional quantitative coronary angiography (QCA).Two methods both could assess target vessel, can obtain coronary artery anatomical structure and lesion position, length, stenosis, diameter, etc, and guide the interventional treatment. Visual estimation is performed through the observation coronary angiography results and to subjectively estimate lesions, this method is simple, while lacks of objective evaluation index, is easily influenced by human factors. Visual estimation requires operators to have high level of interpretation of angiography, often needs accumulated experience, and contains certain subjectivity. Two-dimensional QCA evaluates coronary angiography results through computer analysis, can evaluate lesions stenosis degree, lesions length, lesions minimum diameter, increases the objectivity of interpretation, At present Catheter Room generally has this analysis software. Two-dimensional QCA has better ability to evaluate short or straight the lesions, while its shortcoming is that evaluation ability of long or/and distorted lesions is poor. The accuracy of two-dimensional QCA sometimes still depends on the software analytical capability. Two-dimensional QCA exists deficiency of inadequate information on target vascular lesions, poor assessment of long or/and distorted lesions for PCI therapy. Two-dimensional QCA still exists deficiency, such as the loss of space structure, vascular overlap, vascular shortening. Because of individual characteristics, in order to get more lesion information, such as vascular structure, lesions length, vascular stenosis rate, optimal viewing angle, the operator needs more X-ray projection. Multi-angle X-ray projection to get the more lesion information usually is difficult for yong operator, needs clinical experience, increase medical staff and patients X-ray radiation dose and contrast agent dose, increase the risk of contrast nephropathy.New three dimensional QCA has good clinical practicality to realization of three dimensional coronary reconstruction according to two picture> 25°angiographic images.it has the function of automatic analysis of target lesion, such as lesion length, diameter, stenosis rate, minimum diameter, narrow rate, reference vascular diameter, bifurcate lesions angle, and also has the function of automatic analysis of straight or bifurcate lesions optimal viewing angle (OVA), predict vascular overlap angle, etc. New three dimensional QCA can provide more lesion information for operator than two-dimensional QCA, may be make the PCI oPeration Easily.What is the difference among new three-dimensional QCA, two-dimensional QCA and visual estimation is unknown, practicality of new three-dimensional QCA in clinical Practice is unknown, If there are differences, whether three-dimensional QCA is more accurate? Whether optimal viewing angle recommend by three-dimensional QCA is better than the actual intervention angle? whether optimal viewing angle can provide clearer viewinging angle? these are unknown.The same coronary vascular segment is difference in plane measurement length in different view angle, whether oPtimal viewing angle of the same coronary vascular segment among different people have some rules to obtain is unclear.Bifurcate lesion in the lesions need PCI accounts for 15～16%,its’ interventional therapy has many problems, which is one of the most challenging PCI operation. operator need clearly understand bifurcation vessel anatomic structure among trunk, main branch and side branch, also need know the angle between main branch and side branch, which is important information for guide wire passing into target blood vessels, plaque transposition, complications after stents releasing. One of the key for solving bifurcation lesions intervention problem is to exposure anatomical as possible structure and provide clear viewing angle when in intervention. whether the optimal viewing angle recommend by three-dimensional QCA is better than the actual intervention angle is unknown, best shots without regularity according to angle is unclear. whether optimal viewing angle of each bifurcate vascular among different people have some rules to obtain is unclear. This article consists of four parts.PartⅠComparative study for the assessments of target vessel by three-dimensional, two-dimensional quantitative coronary X-ray angiography and visual estimationObjective:To study the difference among three-dimensional (3D), two-dimensional (2D) quantitative coronary x-ray angiograPhy (QCA) and visual estimation on the assessments of target vessel.Methods:Sixty patients (65 vessel segments) who underwent coronary angiography and interventional stent-procedure were retrospectively included in this study. The area stenosis, diameter stenosis, lesion length, and reference diameter assessed by Medis 3D QCA, Siemens 2D QCA and visual estimation were comPared.Results:62 target vessel were successfully three-dimensional reconstructed from 65 vessel segments,3 target vessel were excluded from the study due to the lack of a second angiographic view for 3D reconstruction. There were significant differences in the assessments of area stenosis (73.87±8.98 vs 79.10±8.06 vs 83.53±8.19, P<0.001), diameter stenosis (54.21±9.48 vs 57.84±10.17, P=0.016), lesion length (28.95±17.31 vs 26.2±16.04 vs 27.21±16.58, P<0.001), reference diameter (2.67±0.29 vs 2.64±0.26 vs 2.76±0.29, P<0.001) by 3D QCA,2D QCA and visual estimation. Conclusion:Coronary X-ray angiography can be successfully three-dimensional reconstructed by Medis 3D QCA. Compared with 2D QCA and visual estimation,3D QCA can restore the true dimensions of vessel morphology and hence, to better assess coronary artery disease.3D QCA system can restore anatomical three-dimensional space structure and analyze more accurately coronary artery lesion. On target vascular length assessment, three-dimensional QCA assessment is longer than two-dimensional QCA assessment, and closer to the real length. visual estimation is longer than two-dimensional QCA assessment. On target vascular aera stenosis rate assessment,3D QCA assessment is less than 2D QCA and visual estimation, visual estimation is more serious; On target vascular reference diameter assessment,3D QCA assessment is larger than 2D QCA and visual estimation, less than visual estimation.PartⅡ:Comparative study for assessment of target vessel with single stenosis between optimal angle calculated by three-dimensional quantitative coronaryangiography and intervention angleObject:To evaluate whether optimal angle suggesteded by three-dimensional quantitative coronaryangiography is better than actually intervention angle in target vessels with single stenosis.Methods:Sixty patients (65 vessel segments) who underwent coronary angiography and interventional stent-Procedure were retrospectively randomly included in this study. Target vessel was three-dimensional reconstructed from two coronary angiography views and optimal angle with the least shorten ratio and extend ratio was automatically calculated. two experienced interventional cardiologists evaluate the advantage and the feasibility compared with actual intervention angle, The evaluation results were quantified into five score levels ranging from -2 to 2. The shorten ratio in optimal angle was compared with that in intervention angle, projection number in optimal angle (equals projection number of successfully three dimensional reconstruction needed) was compared with that in ideal intervention angle.Results:62 target vessel were successfully three-dimensional reconstructed from 65 vessel segments,3 target vessel were excluded from the study due to the lack of a second angiograPhic view for 3D reconstruction. The rate of three-dimensional reconstruction can achieve 100%, the score of optimal angle was significantly higher than actual intervention angle (mean score of optimal,1.41±0.62, P<0.01), the shorten ratio in optimal angle was significantly less than that in actual intervention angle (2.35±2.10 vs 9.27±7.82, P<0.01), the projection number in optimal angle was significantly less than that in ideal intervention angle (2.08±0.27 vs 2.5±0.65, P<0.01)Conclusion:the optimal viewing angle of target vessel can be accurately and quickly calculated by by Medis 3D system. Compared with actual intervention angle, the optimal angles have less shorten ratio and need less projection number. The optimal viewing angle is better than intervention angle. The optimal angles was relatively scattered, evenly distributed, the intervention angle of the same vascular were relatively concentrated, the intervention angles of different segment of one vascular have no significant difference.PartⅢ:Study of the optimal viewing angle was recommended by three-dimensional QCA on each vessel segmentsObjective:To explore the optimal viewing angle distribution characteristics of different vascular segment (proximal RCA, middle RCA, distal RCA, left main trunk, proximal LAD, middle LAD, distal LAD, proximal LCX, distal LCX)through the coronary three reconstruction and calculation.Method:76 Patients (185 vessel segments) who underwent coronary angiography were retrospectively randomly included in this study. Target vessel was three-dimensional reconstructed from two coronary angiography views and optimal angle with the least shorten ratio and extend ratio was automatically calculated.two vessel segments were abandoned (one vessel because of overlaping in the beginning position, one vessel because of occlusion in proximal LCX. The optimal viewing angle of different vessels were analyzed.Result:183 target vessel segments were successfully reconstructed and its optimal viewing angle were calculated. the length shorten ratio in optimal viewing angle compared with conventional angle in 9 target vessels:is 2.51±2.12 vs 7.89±12.61 (P=0.032,95%CI:-10.24～-0.51) in 25 left main trunks, is 3.15±3.38 vs 9.40±8.63 (P=0.002,95%CI:-9.96～-2.55) in 20 proximal RCAs, is 3.84±3.09 vs 8.19±8.94 (P=0.033,95%CI:-8.32～-0.38) in 20 middle RCAs, is 3.87±2.69 vs 9.07±9.79, (P=0.040,95%CI:-10.14～-0.28) in 20 distal RCAs, is 2.54±2.06 vs 10.70±8.90 (P=0.001,95%CI:-12.25～-4.07) in 20 proximal LADs,is 2.65±2.14 vs 8.14±7.85 (P=0.004,95%CI:-8.98～-1.99) in 20 middle LADs, is 2.83±1.85 vs 7.02±4.32 (P<0.001,95%CI:-5.99～-2.38) in 20 distal LAD, these seven vessel have statistically significant difference. those of proximal LCXs, distal LCXs have no statistically significant difference.The optimal viewing angle of each target vessl:is RAO:-12.3±22.31+ CAUD:15.7±11.49 of proximal RCA, is RAO-8.85±27.7+CAUD:18.12±19.10 of middle RCA, is RAO-21.75±24.73+CAUD:-20.00±21.38 of distal RCA, is RAO5.68±19.60+CAUD:3.92±22.54 of left main trunk, is RAO:35.55±11.40+ CAUD:-5.25±23.12 of proximal LAD,is RAO:27.05±9.25+CAUD:-25.95±31.31 of middle LAD, is RAO:-3.50±23.11+CAUD:-20.15±11.04 of distal LAD, is RAO-25.79±22.05+CAUD22.53±18.05 of proximal LCX, RAO-1.21±25.26+ CAUD13.16±13.76 of distal LCX. Conclusion:Left main trunk and different segments of three main branch vessls can reconstructed successfully, explore the optimal viewing angle distribution characteristics of different vascular segment through the coronary three reconstruction and calculation has a very good feasibility. The length shorten ratios in optimal viewing angle which are left main trunk, distal LAD, proximal LCX, distal LCX are less than conventional angle. The optimal viewing angle of left main trunk is scattered, right anterior oblique adds caudal is preferred. The optimal viewing angle of proximal RCA is left anterior oblique adds cranial, The optimal viewing angle of proximal LCX and distal LCX is left anterior oblique adds caudal.PartⅣ:study on the optimal viewing angle of bifurcation target-vesselObjective:To assess the optimal viewing angle of bifurcation target vessl through three-dimensional reconstruction and explorer distribution characteristics of the optimal viewing angle of the LAD-D1 bifurcation, the LCX-OM bifurcation, the distal RCA bifurcation and LMT bifurcation.Method:76 Patients (85 bifurcation target vessls which 53 bifurcation underwent intervention) who underwent coronary angiography were retrospectively randomly included in this study. Target vessel was three-dimensional reconstructed from two coronary angiography views and optimal angle with the least shorten ratio and extend ratio was automatically calculated. The optimal viewing angle was assessed compared with intervention angle, distribution characteristics of the optimal viewing angles of four bifurcation vessels were analyzed.Result:85 target bifurcation vessel were successfully reconstructed and its optimal viewing angle were calculated. The score of the optimal viewing angle in 53 patients was 1.46±0.54 (95%CI:1.31～1.61) compared with the intervention angle, all score of the optimal viewing were more than 0 point (P=0.000).the number of projection used three dimensional reconstruction software compared with intervention is 2.09±0.30 vs 2.79±0.69 (P=0.000).the length shorten ratio in optimal viewing angle compared with intervention angle in bifurcation vessel:is 4.85±3.35 vs 12.55±7.00 (P=0.000)in 53 main branch, is 6.06±3.21 vs 12.59±7.04(P=0.000)in side branch. The optimal viewing angle of each target vessl:is RAO10.95±29.98+CAUD-43.3±28.60 of LAD-D1 bifurcation, is RAO-3.25±38.56+CAUD23.2±29.05 of LCX-OM bifurcation, is RAO-31.3±15.00+CAUD-17.35±27.05 of distal RCA bifurcation, is RAO6.44±48.99+CAUD21.48±46.60 of LMT bifurcation.Conclusion:bifurcation vessls can reconstructed successfully, explore the optimal viewing angle distribution characteristics of different bifurcation vessls through the coronary three reconstruction and calculation has a very good feasibility. The length shorten ratios of main branch and side branch in optimal viewing angle are less than intervention angle. The optimal viewing angle of LAD-D1 bifurcation is right anterior oblique adds cranial is preferred. The optimal viewing angle of LCX-OM bifurcation is left anterior oblique adds caudal, The optimal viewing angle of distal RCA bifurcation is left anterior oblique adds cranial. The optimal viewing angle of LMT bifurcation is right anterior oblique adds caudal, the second is left anterior oblique adds caudal.Summary:1) Medis 3D QCA can achieve successfully three dimensional reconstruction, compare with two dimensional QCA and visual estimation, can restore three dimensional anatomic structure and more accurately analyze vessls lesion.2) Coronary three-dimensional reconstruction system can accurately and quickly generate the optimal angle that has less shorten ratio in plane and can help reduce the number of projection for intervention.3) Coronary three-dimensional reconstruction system can achieve successfully three dimensional reconstruction of Left main trunk and different segments of three main branch vessls. explore the optimal viewing angle distribution characteristics of different vascular segment through the coronary three reconstruction and calculation has a very good feasibility. The optimal viewing angle of left main trunk is scattered, right anterior oblique adds caudal is Preferred. The optimal viewing angle of proximal RCA is left anterior oblique adds cranial, The optimal viewing angle of proximal LCX and distal LCX is left anterior oblique adds caudal.4) The optimal viewing angle is better than intervention angle, The length shorten ratios of main branch and side branch in optimal viewing angle are less than intervention angle, the optimal viewing angle of LAD-D1 bifurcation is right anterior oblique adds cranial is preferred. The optimal viewing angle of LCX-OM bifurcation is left anterior oblique adds caudal, The optimal viewing angle of distal RCA bifurcation is left anterior oblique adds cranial. The optimal viewing angle of LMT bifurcation is right anterior oblique adds caudal, the second is left anterior oblique adds caudal. |
PDF Full Text Request