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Open Access 01-10-2018 | Original Article

Predictive performance of dual modality of computed tomography angiography and intravascular ultrasound for no-reflow phenomenon after percutaneous coronary stenting in stable coronary artery disease

Authors: Masaaki Okutsu, Takeshi Horio, Hisataka Tanaka, Maki Akiyama, Niro Okimoto, Toshiyuki Tsubouchi, Kenji Kawajiri, Yasuhiro Ohashi, Satoru Sumitsuji, Yuji Ikari

Published in: Heart and Vessels | Issue 10/2018

Abstract

Attenuated plaque on intravascular ultrasound (IVUS) and low attenuation plaque on computed tomography angiography (CTA) are associated with no-reflow phenomenon during percutaneous coronary intervention (PCI). However, evaluation by a single modality has been unable to satisfactorily predict this phenomenon. We investigated whether the combination of IVUS and CTA findings can ameliorate the predictive potential for no-reflow phenomenon after stent implantation during PCI in stable coronary artery disease (CAD). A total of 988 lesions of 707 stable CAD patients who underwent coronary CTA before PCI were enrolled. PCI was performed with preprocedural IVUS and stent implantation. As for plaque characters, very low attenuation plaque (CTA v-LAP) whose minimum density was < 0 Hounsfield units on CTA and attenuated plaque (IVUS AP) on IVUS were evaluated. No-reflow phenomenon was observed in 22 lesions (2.2%) of 19 patients (2.7%). Both CTA v-LAP and IVUS AP were much more frequently observed in patients with no-reflow phenomenon. Positive (PPV) and negative predictive values (NPV) and accuracy for prediction of no-reflow were almost equivalent between CTA v-LAP (13.2, 99.6, and 87.0%) and IVUS AP (15.7, 99.8, and 89.0%). The combination of CTA v-LAP and IVUS AP markedly ameliorated PPV (31.7%) without deterioration of NPV (99.7%) and increased the diagnostic accuracy (95.5%). These findings showed that the combination of CTA v-LAP and IVUS AP improved the predictive power for no-reflow phenomenon after coronary stenting in stable CAD patients, suggesting the usefulness of combined estimation by using CTA and IVUS for predicting no-reflow phenomenon during PCI in clinical practice.

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Ito H, Tomooka T, Sakai N, Yu H, Higashino Y, Fujii K, Masuyama T, Kitabatake A, Minamino T (1992) Lack of myocardial perfusion immediately after successful thrombolysis. A predictor of poor recovery of left ventricular function in anterior myocardial infarction. Circulation 85:1699–1705CrossRefPubMed

Piana RN, Paik GY, Moscucci M, Cohen DJ, Gibson CM, Kugelmass AD, Carrozza JP Jr, Kuntz RE, Baim DS (1994) Incidence and treatment of ‘no-reflow’ after percutaneous coronary intervention. Circulation 89:2514–2518CrossRefPubMed

Wu KC, Zerhouni EA, Judd RM, Lugo-Olivieri CH, Barouch LA, Schulman SP, Blumenthal RS, Lima JA (1998) Prognostic significance of microvascular obstruction by magnetic resonance imaging in patients with acute myocardial infarction. Circulation 97:765–772CrossRefPubMed

Morishima I, Sone T, Okumura K, Tsuboi H, Kondo J, Mukawa H, Matsui H, Toki Y, Ito T, Hayakawa T (2000) Angiographic no-reflow phenomenon as a predictor of adverse long-term outcome in patients treated with percutaneous transluminal coronary angioplasty for first acute myocardial infarction. J Am Coll Cardiol 36:1202–1209CrossRefPubMed

Yip HK, Chen MC, Chang HW, Hang CL, Hsieh YK, Fang CY, Wu CJ (2002) Angiographic morphologic features of infarct-related arteries and timely reperfusion in acute myocardial infarction: predictors of slow-flow and no-reflow phenomenon. Chest 122:1322–1332CrossRefPubMed

Resnic FS, Wainstein M, Lee MK, Behrendt D, Wainstein RV, Ohno-Machado L, Kirshenbaum JM, Rogers CD, Popma JJ, Piana R (2003) No-reflow is an independent predictor of death and myocardial infarction after percutaneous coronary intervention. Am Heart J 145:42–46CrossRefPubMed

Okura H, Taguchi H, Kubo T, Toda I, Yoshida K, Yoshiyama M, Yoshikawa J (2007) Atherosclerotic plaque with ultrasonic attenuation affects coronary reflow and infarct size in patients with acute coronary syndrome: an intravascular ultrasound study. Circ J 71:648–653CrossRefPubMed

Wu X, Mintz GS, Xu K, Lansky AJ, Witzenbichler B, Guagliumi G, Brodie B, Kellett MA Jr, Dressler O, Parise H, Mehran R, Stone GW, Maehara A (2011) The relationship between attenuated plaque identified by intravascular ultrasound and no-reflow after stenting in acute myocardial infarction. JACC Cardiovasc Interv 4:495–502CrossRefPubMed

Suda A, Namiuchi S, Kawaguchi T, Nihei T, Takii T, Saji K, Sugie T, Kato A, Shimokawa H (2016) A simple and rapid method for identification of lesions at high risk for the no-reflow phenomenon immediately before elective coronary stent implantation. Heart Vessels 31:1904–1914CrossRefPubMed

10.

Watanabe Y, Sakakura K, Taniguchi Y, Yamamoto K, Wada H, Fujita H, Momomura S (2017) Determinants of slow flow following stent implantation in intravascular ultrasound-guided primary percutaneous coronary intervention. Heart Vessels. https://doi.org/10.1007/s00380-017-1050-z CrossRefPubMed

11.

Meijboom WB, Meijs MF, Schuijf JD, Cramer MJ, Mollet NR, van Mieghem CA, Nieman K, van Werkhoven JM, Pundziute G, Weustink AC, de Vos AM, Pugliese F, Rensing B, Jukema JW, Bax JJ, Prokop M, Doevendans PA, Hunink MG, Krestin GP, de Feyter PJ (2008) Diagnostic accuracy of 64-slice computed tomography coronary angiography: a prospective, multicenter, multivendor study. J Am Coll Cardiol 52:2135–2144CrossRefPubMed

12.

Miller JM, Rochitte CE, Dewey M, Arbab-Zadeh A, Niinuma H, Gottlieb I, Paul N, Clouse ME, Shapiro EP, Hoe J, Lardo AC, Bush DE, de Roos A, Cox C, Brinker J, Lima JA (2008) Diagnostic performance of coronary angiography by 64-row CT. N Engl J Med 359:2324–2336CrossRefPubMed

13.

Taylor AJ, Cerqueira M, Hodgson JM, Mark D, Min J, O’Gara P, Rubin GD (2010) ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 appropriate use criteria for cardiac computed tomography: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance. J Am Coll Cardiol 56:1864–1894CrossRefPubMed

14.

Schroeder S, Kopp AF, Baumbach A, Meisner C, Kuettner A, Georg C, Ohnesorge B, Herdeg C, Claussen CD, Karsch KR (2001) Noninvasive detection and evaluation of atherosclerotic coronary plaques with multislice computed tomography. J Am Coll Cardiol 37:1430–1435CrossRefPubMed

15.

Nakazato R, Otake H, Konishi A, Iwasaki M, Koo BK, Fukuya H, Shinke T, Hirata K, Leipsic J, Berman DS, Min JK (2015) Atherosclerotic plaque characterization by CT angiography for identification of high-risk coronary artery lesions: a comparison to optical coherence tomography. Eur Heart J Cardiovasc Imaging 16:373–379CrossRefPubMed

16.

Harigaya H, Motoyama S, Sarai M, Inoue K, Hara T, Okumura M, Naruse H, Ishii J, Hishida H, Ozaki Y (2011) Prediction of the no-reflow phenomenon during percutaneous coronary intervention using coronary computed tomography angiography. Heart Vessels 26:363–369CrossRefPubMed

17.

Motoyama S, Kondo T, Sarai M, Sugiura A, Harigaya H, Sato T, Inoue K, Okumura M, Ishii J, Anno H, Virmani R, Ozaki Y, Hishida H, Narula J (2007) Multislice computed tomographic characteristics of coronary lesions in acute coronary syndromes. J Am Coll Cardiol 50:319–326CrossRefPubMed

18.

Motoyama S, Sarai M, Harigaya H, Anno H, Inoue K, Hara T, Naruse H, Ishii J, Hishida H, Wong ND, Virmani R, Kondo T, Ozaki Y, Narula J (2009) Computed tomographic angiography characteristics of atherosclerotic plaques subsequently resulting in acute coronary syndrome. J Am Coll Cardiol 54:49–57CrossRefPubMed

19.

Motoyama S, Ito H, Sarai M, Kondo T, Kawai H, Nagahara Y, Harigaya H, Kan S, Anno H, Takahashi H, Naruse H, Ishii J, Hecht H, Shaw LJ, Ozaki Y, Narula J (2015) Plaque characterization by coronary computed tomography angiography and the likelihood of acute coronary events in mid-term follow-up. J Am Coll Cardiol 66:337–346CrossRefPubMed

20.

Otsuka K, Fukuda S, Tanaka A, Nakanishi K, Taguchi H, Yoshikawa J, Shimada K, Yoshiyama M (2013) Napkin-ring sign on coronary CT angiography for the prediction of acute coronary syndrome. JACC Cardiovasc Imaging 6:448–457CrossRefPubMed

21.

Napel S, Rubin GD, Jeffrey RB Jr (1993) STS-MIP: a new reconstruction technique for CT of the chest. J Comput Assist Tomogr 17:832–838CrossRefPubMed

22.

Choi JW, Seo JB, Do KH, Choi SI, Lee W, Ko SM, Lee SH, Lee JS, Song JW, Song KS, Lim TH (2006) Comparison of transaxial source images and 3-plane, thin-slab maximal intensity projection images for the diagnosis of coronary artery stenosis with using ECG-gated cardiac CT. Korean J Radiol 7:20–27CrossRefPubMedPubMedCentral

23.

Shiono Y, Kubo T, Tanaka A, Tanimoto T, Ota S, Ino Y, Aoki H, Ozaki Y, Orii M, Shimamura K, Ishibashi K, Yamano T, Yamaguchi T, Hirata K, Imanishi T, Akasaka T (2013) Impact of attenuated plaque as detected by intravascular ultrasound on the occurrence of microvascular obstruction after percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction. JACC Cardiovasc Interv 6:847–853CrossRefPubMed

24.

Kini AS, Motoyama S, Vengrenyuk Y, Feig JE, Pena J, Baber U, Bhat AM, Moreno P, Kovacic JC, Narula J, Sharma SK (2015) Multimodality intravascular imaging to predict periprocedural myocardial infarction during percutaneous coronary intervention. JACC Cardiovasc Interv 8:937–945CrossRefPubMed

25.

Lee SY, Mintz GS, Kim SY, Hong YJ, Kim SW, Okabe T, Pichard AD, Satler LF, Kent KM, Suddath WO, Waksman R, Weissman NJ (2009) Attenuated plaque detected by intravascular ultrasound: clinical, angiographic, and morphologic features and post-percutaneous coronary intervention complications in patients with acute coronary syndromes. JACC Cardiovasc Interv 2:65–72CrossRefPubMed

26.

Nakazawa G, Tanabe K, Onuma Y, Yachi S, Aoki J, Yamamoto H, Higashikuni Y, Yagishita A, Nakajima H, Hara K (2008) Efficacy of culprit plaque assessment by 64-slice multidetector computed tomography to predict transient no-reflow phenomenon during percutaneous coronary intervention. Am Heart J 155:1150–1157CrossRefPubMed

27.

Kodama T, Kondo T, Oida A, Fujimoto S, Narula J (2012) Computed tomographic angiography-verified plaque characteristics and slow-flow phenomenon during percutaneous coronary intervention. JACC Cardiovasc Interv 5:636–643CrossRefPubMed

28.

Kinohira Y, Akutsu Y, Li HL, Hamazaki Y, Sakurai M, Saiki Y, Kodama Y, Nishimura H, Yamanaka H, Shinozuka A, Gokan T, Katagiri T (2007) Coronary arterial plaque characterized by multislice computed tomography predicts complications following coronary intervention. Int Heart J 48:25–33CrossRefPubMed

29.

Uetani T, Amano T, Kunimura A, Kumagai S, Ando H, Yokoi K, Yoshida T, Kato B, Kato M, Marui N, Nanki M, Matsubara T, Ishii H, Izawa H, Murohara T (2010) The association between plaque characterization by CT angiography and post-procedural myocardial infarction in patients with elective stent implantation. JACC Cardiovasc Imaging 3:19–28CrossRefPubMed

30.

Wu X, Maehara A, Mintz GS, Kubo T, Xu K, Choi SY, He Y, Guo N, Moses JW, Leon MB, De Bruyne B, Serruys PW, Stone GW (2010) Virtual histology intravascular ultrasound analysis of non-culprit attenuated plaques detected by grayscale intravascular ultrasound in patients with acute coronary syndromes. Am J Cardiol 105:48–53CrossRefPubMed

31.

Pu J, Mintz GS, Biro S, Lee JB, Sum ST, Madden SP, Burke AP, Zhang P, He B, Goldstein JA, Stone GW, Muller JE, Virmani R, Maehara A (2014) Insights into echo-attenuated plaques, echolucent plaques, and plaques with spotty calcification. Novel findings from comparisons among intravascular ultrasound, near-infrared spectroscopy, and pathological histology in 2,294 human coronary artery segments. J Am Coll Cardiol 63:2220–2233CrossRefPubMed

32.

Bayturan O, Tuzcu EM, Nicholls SJ, Balog C, Lavoie A, Uno K, Crowe TD, Magyar WA, Wolski K, Kapadia S, Nissen SE, Schoenhagen P (2009) Attenuated plaque at nonculprit lesions in patients enrolled in intravascular ultrasound atherosclerosis progression trials. JACC Cardiovasc Interv 2:672–678CrossRefPubMed

33.

Leipsic J, Abbara S, Achenbach S, Cury R, Earls JP, Mancini GJ, Nieman K, Pontone G, Raff GL (2014) SCCT guidelines for the interpretation and reporting of coronary CT angiography: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee. J Cardiovasc Comput Tomogr 8:342–358CrossRefPubMed

Title: Predictive performance of dual modality of computed tomography angiography and intravascular ultrasound for no-reflow phenomenon after percutaneous coronary stenting in stable coronary artery disease
Authors: Masaaki Okutsu
Takeshi Horio
Hisataka Tanaka
Maki Akiyama
Niro Okimoto
Toshiyuki Tsubouchi
Kenji Kawajiri
Yasuhiro Ohashi
Satoru Sumitsuji
Yuji Ikari
Publication date: 01-10-2018
Publisher: Springer Japan
Published in: Heart and Vessels / Issue 10/2018
Print ISSN: 0910-8327
Electronic ISSN: 1615-2573
DOI: https://doi.org/10.1007/s00380-018-1160-2

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