관상동맥 조영술과 중재술을 위한 요골 접근법 : 시술 건수가 많은 심도자실에서의 경험과 안전성 Practical Applicability at a High-Volume Laboratory and Safety in Korean Patients

차광수,김무현,김영대,김혜진,손영기,박성욱,이철종,이종훈,박정운,김성현,김종성 대한순환기학회 1998 Korean Circulation Journal Vol.28 No.9

CT Angiography-Derived RECHARGE Score Predicts Successful Percutaneous Coronary Intervention in Patients with Chronic Total Occlusion

Li Jiahui,Wang Rui,Tesche Christian,Schoepf U. Joseph,Pannell Jonathan T.,He Yi,Huang Rongchong,Chen Yalei,Li Jianan,Song Xiantao 대한영상의학회 2021 Korean Journal of Radiology Vol.22 No.5

Objective: To investigate the feasibility and the accuracy of the coronary CT angiography (CCTA)-derived Registry of Crossboss and Hybrid procedures in France, the Netherlands, Belgium and United Kingdom (RECHARGE) score (RECHARGECCTA) for the prediction of procedural success and 30-minutes guidewire crossing in percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). Materials and Methods: One hundred and twenty-four consecutive patients (mean age, 54 years; 79% male) with 131 CTO lesions who underwent CCTA before catheter angiography (CA) with CTO-PCI were retrospectively enrolled in this study. The RECHARGECCTA scores were calculated and compared with RECHARGECA and other CTA-based prediction scores, including Multicenter CTO Registry of Japan (J-CTO), CT Registry of CTO Revascularisation (CT-RECTOR), and Korean Multicenter CTO CT Registry (KCCT) scores. Results: The procedural success rate of the CTO-PCI procedures was 72%, and 61% of cases achieved the 30-minutes wire crossing. No significant difference was observed between the RECHARGECCTA score and the RECHARGECA score for procedural success (median 2 vs. median 2, p = 0.084). However, the RECHARGECCTA score was higher than the RECHARGECA score for the 30-minutes wire crossing (median 2 vs. median 1.5, p = 0.001). The areas under the curve (AUCs) of the RECHARGECCTA and RECHARGECA scores for predicting procedural success showed no statistical significance (0.718 vs. 0.757, p = 0.655). The sensitivity, specificity, positive predictive value, and the negative predictive value of the RECHARGECCTA scores of ≤ 2 for predictive procedural success were 78%, 60%, 43%, and 87%, respectively. The RECHARGECCTA score showed a discriminative performance that was comparable to those of the other CTA-based prediction scores (AUC = 0.718 vs. 0.665–0.717, all p > 0.05). Conclusion: The non-invasive RECHARGECCTA score performs better than the invasive determination for the prediction of the 30-minutes wire crossing of CTO-PCI. However, the RECHARGECCTA score may not replace other CTA-based prediction scores for predicting CTO-PCI success.

관상동맥 CT 조영술을 활용한 스텐트 재협착 평가: 과거와 현재 최신 동향으로의 여정

Yoon Seong Lee,Eun-Ah Park,Whal Lee 대한영상의학회 2024 대한영상의학회지 Vol.85 No.2

관상동맥병 환자의 치료에 풍선팽창스텐트 치료는 현재 가장 흔히 시행되는 관상동맥재개통 치료법이다. 그러나 경피적 관상동맥 중재술 이후 재협착은 여전히 주요 합병증으로 남아 있다. 스텐트 재협착을 진단하기 위한 도구로서 관상동맥 CT 조영술(coronary CT angiography; 이하 CCTA)는 과거에는 주로 번짐허상과 움직임허상으로 인해 내강을 정확히 판단하기 어려워 그 역할이 제한적이었다. 따라서 정확한 확인을 위해서 침습적인 고식적 관상동맥 조영술로 넘어가는 경우가 많았다. 그러나 근래 CT 기술의 발달로 민감도와 특이도가 모두 개선되면서 그 역할이 중요해지고 있으며, 특히 일관되게 음성예측도가 높게 보고되고 있다. 본 종설에서는 CCTA를 이용한 관상동맥 스텐트 재협착 진단의 과거와 현재, 그리고 최신 동향에 대해 알아보고자 한다. Treatment of patients with coronary artery disease commonly involves the use of balloon-expandable stent placements, currently recognized as the most prevalent approach for coronary artery revascularization. Nevertheless, the occurrence of restenosis remains a significant complication following percutaneous coronary interventions. The diagnostic role of coronary CT angiography (CCTA) in detecting stent restenosis has limitations primarily attributable to challenges in accurately discerning the lumen, due to issues such as blooming and motion artifacts. As a result, many cases often necessitate a transition to conventional coronary angiography. However, recent advancements in CT technology have led to notable improvements in both sensitivity and specificity, underscoring the growing significance of CCTA as a diagnostic tool. The consistent reporting of high negative predictive value is particularly noteworthy. This review aims to explore the historical context, current status, and recent trends in diagnosing coronary artery stent restenosis using CCTA.

Current Practice of Transradial Coronary Angiography and Intervention: Results from the Korean Transradial Intervention Prospective Registry

윤영진,이준원,안성균,이승환,윤정한,조병렬,정상식,김희열,이재환,배장호,이진배,서존,박금수,한규록,정명호,나승운,허성호,조윤행,김상욱 대한심장학회 2015 Korean Circulation Journal Vol.45 No.6

Background and Objectives: Although increasing evidence has indicated that radial access is a beneficial technique, few studies have focused on Korean subjects. The aim of this study was to evaluate current practice of coronary angiography (CAG) and percutaneous coronary intervention (PCI) using radial access in South Korea. Subjects and Methods: A total of 6338 subjects were analyzed from Korean Transradial Intervention prospective registry that was conducted at 20 centers in Korea. After evaluating the initial access, subjects intended for radial access were assessed for their baseline, procedure-related, and complication data. Subjects were categorized into three groups: group of overall subjects (n=5554); group of subjects who underwent PCI (n=1780); and group of subjects who underwent primary percutaneous coronary intervention (PPCI) (n=167). Results: The rate of radial artery as an initial access and the rate of access site crossover was 87.6% and 4.4%, respectively, in overall subjects. Those rates were 82.4% and 8.1%, respectively, in subjects who underwent PCI, and 60.1% and 4.8%, respectively, in subjects who underwent PPCI. For subjects who underwent CAG, a 6-F introducer sheath and a 5-F angiographic catheter was the most commonly used. During PCI, a 6-F introducer sheath (90.6%) and a 6-F guiding catheter were standardly used. Conclusion: The large prospective registry allowed us to present the current practice of CAG and PCI using radial access. These data provides evidence to achieve consensus on radial access in CAG and PCI in the Korean population.

Optical Coherence Tomography-Guided Percutaneous Intervention: A Comparative Study

Sanjeeb Roy,Ashwini Sharma,Anurodh Dadarwal,Krishna Kumar Sharma,Manish Narang,Nick E.J. West 아시아심장혈관영상의학회 2024 Cardiovascular Imaging Asia Vol.8 No.1

Objective: Optical coherence tomography (OCT) is considered superior to coronary angiography (CA). However, OCT is not widely used, and data are limited in India. In the present study, the efficacy and safety of OCT for guiding percutaneous coronary intervention (PCI) in all-comer patients were evaluated and compared with those of CA. Materials and Methods: In this retrospective study, the data associated with 434 patients who underwent PCI between December 2018 and June 2020 were analyzed. The primary endpoint was major adverse cardiac events (MACEs) at 6 months. Results: The patients were divided into OCT-guided and angiography-guided PCI groups (217 in each group) after propensity matching. The OCT-guided PCI group had a significantly larger proportion of patients with unstable angina (55.7% vs. 43.3%, p=0.009) and non-ST-elevation myocardial infarction (NSTEMI; 17.5% vs. 10.0%, p=0.02) compared with the angiography-guided PCI group, and the proportion of patients with STEMI was significantly lower in the OCT-guided PCI group than in the angiography-guided PCI group (23.5% vs. 41.5%, p=0.00005). The OCT-guided PCI group had a lower incidence of MACEs at 6 months than the angiography-guided PCI group but without statistical significance (6.9% vs. 9.7%, p=0.296). Incidences of target lesion failure, target vessel myocardial infarction, in-stent restenosis, or stent thrombosis did not occur in either group. On post-PCI OCT, stent underexpansion, tissue prolapse, stent edge dissection, and stent malapposition were observed in 28.5%, 10%, 4.1%, and 3.7% of the cases, respectively. Conclusion: When comparing OCT-guided PCI with angiography-guided PCI, OCT-guided PCI showed slightly superior clinical outcomes at 6 months, although the differences were not statistically significant.

Natural History of Untreated Coronary Total Occlusions Revealed with Follow-Up Semi-Automated Quantitative Coronary CT Angiography: The Morphological Characteristics of Initial CT Predict Occlusion Shortening

Qian Wu,Mengmeng Yu,Yuehua Li,Wenbin Li,Zhigang Lu,Meng Wei,Jing Yan,Jiayin Zhang 대한영상의학회 2018 Korean Journal of Radiology Vol.19 No.2

Objective: To investigate the morphological changes of coronary chronic total occlusion (CTO) as determined by coronary computed tomography angiography (CCTA) follow-up using semi-automated quantitative analysis. Materials and Methods: Thirty patients with 31 CTO lesions confirmed by invasive coronary angiography and baseline/follow-up CCTA were retrospectively included. CTOs were quantitatively analyzed by a semi-automated coronary plaque analysis software (Coronary Plaque Analysis, version 2.0, Siemens) after manually determining the lesion border. Recanalized lumen was defined as the linear-like enhanced opacity traversing the non-opacified occluded segment. Other parameters, such as total occlusion length, total occlusion volume, volume with low attenuation component (< 30 Hounsfield unit [HU]), volume with middle to high attenuation component (30−190 HU) as well as the calcification volume, were also recorded. Results: Recanalized lumen was found within 48.4% (15/31) occlusions on the follow-up CCTA, compared to 45.2% (14/31) occlusions on the baseline CCTA. Eleven of 14 lesions (78.6%) with CT-visible recanalized lumen within CTOs had a shorter occlusion length on follow-up compared to only 3 of 17 lesions (17.6%) without CT-visible recanalized lumen (odds ratio, 17.1, p < 0.001). The percentage of low attenuation component of occlusions was smaller on follow-up CCTA compared to baseline value (18.1 ± 20.1% vs. 22.6 ± 19.6%, p = 0.033). Conclusion: Coronary computed tomography angiography enables non-invasive characterization of natural progression of untreated CTO lesions. Recanalized lumen within CTOs observed at baseline CCTA was associated with shortening of occlusion length on follow-up. Compared to their earlier stage, occlusions of later stage were presented with higher density of non-calcified components.

Assessment of Image Quality for Selective Intracoronary Contrast-Injected CT Angiography in a Hybrid Angio-CT System: A Feasibility Study in Swine

하성민,정성희,박형복,신상훈,Reza Arsanjani,홍영택,이병권,장영걸,전병환,박세일,심학준,장혁재 연세대학교의과대학 2021 Yonsei medical journal Vol.62 No.3

Purpose: To compare image quality in selective intracoronary contrast-injected computed tomography angiography (SelectiveCTA) with that in conventional intravenous contrast-injected CTA (IV-CTA). Materials and Methods: Six pigs (35 to 40 kg) underwent both IV-CTA using an intravenous injection (60 mL) and Selective-CTA using an intracoronary injection (20 mL) through a guide-wire during/after percutaneous coronary intervention. Images of the common coronary artery were acquired. Scans were performed using a combined machine comprising an invasive coronary angiography suite and a 320-channel multi-slice CT scanner. Quantitative image quality parameters of CT attenuation, image noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), mean lumen diameter (MLD), and mean lumen area (MLA) were measured and compared. Qualitative analysis was performed using intraclass correlation coefficient (ICC), which was calculated for analysis of interobserver agreement. Results: Quantitative image quality, determined by assessing the uniformity of CT attenuation (399.06 vs. 330.21, p<0.001), image noise (24.93 vs. 18.43, p<0.001), SNR (16.43 vs. 18.52, p=0.005), and CNR (11.56 vs. 13.46, p=0.002), differed significantly between IV-CTA and Selective-CTA. MLD and MLA showed no significant difference overall (2.38 vs. 2.44, p=0.068, 4.72 vs. 4.95, p=0.078). The density of contrast agent was significantly lower for selective-CTA (13.13 mg/mL) than for IV-CTA (400 mg/mL). Agreement between observers was acceptable (ICC=0.79±0.08). Conclusion: Our feasibility study in swine showed that compared to IV-CTA, Selective-CTA provides better image quality and requires less iodine contrast medium

Consensus statement on coronary intervention during the coronavirus disease 19 pandemic: from the Korean Society of Interventional Cardiology

Kwan Yong Lee,Bong-Ki Lee,김원장,Se Hun Kang,Taek Kyu Park,Song-Yi Kim,Jung-Won Suh,Chang-Hwan Yoon,Dong Heon Yang,Sung Kee Ryu,Sang-Hyun Kim,Sung Yun Lee,In-Ho Chae,The Korean Society of Interventional 대한내과학회 2020 The Korean Journal of Internal Medicine Vol.35 No.4

Coronavirus disease 2019 (COVID-19) is a highly contagious disease caused by the novel virus severe acute respiratory syndrome coronavirus 2. The first case developed in December, 2019 in Wuhan, China; several months later, COVID-19 has become pandemic, and there is no end in sight. This disaster is also causing serious health problems in the area of cardiovascular intervention. In response, the Korean Society of Interventional Cardiology formed a COVID-19 task force to develop practice guidelines. This special article introduces clinical practice guidelines to prevent secondary transmission of COVID-19 within facilities; the guidelines were developed to protect patients and healthcare workers from this highly contagious virus. We hope these guidelines help healthcare workers and cardiovascular disease patients around the world cope with the COVID-19 pandemic.

Consensus Statement on Coronary Intervention during the Coronavirus Disease 2019 (COVID-19) Pandemic: from the Korean Society of Interventional Cardiology (KSIC)

Kwan-Yong Lee,Bong-Ki Lee,김원장,Se Hun Kang,Taek Kyu Park,Song Yi Kim,Jung-Won Suh,Chang-Hwan Yoon,Dong Heon Yang,Sung Kee Ryu,Sang-Hyun Kim,Sung Yun Lee,In Ho Chae 대한심장학회 2020 Korean Circulation Journal Vol.50 No.11

Coronavirus disease 2019 (COVID-19) is a highly contagious disease caused by the novel virus severe acute respiratory syndrome coronavirus-2. The first case developed in December, 2019 in Wuhan, China; several months later, COVID-19 has become pandemic, and there is no end in sight. This disaster is also causing serious health problems in the area of cardiovascular intervention. In response, the Korean Society of Interventional Cardiology formed a COVID-19 task force to develop practice guidelines. This special article introduces clinical practice guidelines to prevent secondary transmission of COVID-19 within facilities; the guidelines were developed to protect patients and healthcare workers from this highly contagious virus. We hope these guidelines help healthcare workers and cardiovascular disease patients around the world cope with the COVID-19 pandemic.

관상동맥 조영술 및 중재술시 요골동맥과 대퇴동맥의 사용에 관한 비교연구

문일봉 ( Il Bong Moon ),여화연 ( Hwa Yeon Yeo ),임환열 ( Hwan Yeal Lim ),동경래 ( Kyung Rae Dong ) 조선대학교 공학기술연구원 2015 공학기술논문지 Vol.8 No.4

Coronary angiography and interventional study mostly use the methods of radial artery and Femoral artery. The results of 116 patients (65.% male with an average age of 63.3±11.54)who had Coronary angiography and interventional study treatments from June 12th, 2014 to September 2nd, 2014 at the Chonnam National University Hospital were analyzed. For patients who had an angiography with interventional study treatment were divided into two groups (group 1: radial artery, group 2: femoral artery) and analyzed. For the group that used the radial artery the frequency of Coronary angiography interventional study was lower (19.5% vs. 55.9%, p<0.001), and the inner radius was smaller (5.20±0.429french vs. 6.18±0.999french, p<0.001), and the amount of contrast media used was smaller (66.8±43.30cc vs. 105.7±60.30cc, p=0.001). However, there was no difference for gender, age, BMI, type of artery, radiation exposure duration and amount. In the sub-analysis, for the group that only had the Coronary angiography without the interventional study treatment and where the radial artery, the radiation exposure duration was longer than that of the group that used the femoral artery (392.30±205.263sec vs. 282.13±82.984sec, p=0.002). However, there were no differences for the other parameters. Also, for the group that had both the Coronary angiography and interventional study treatment showed no difference for all parameters. In conclusion, it can be stated that Coronary angiography that uses the radial artery and interventional study treatment, which is widely know to be comfortable for the patient and to also lower the risk for hemorrhaging, is a better and safer treatment method.