Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Oct;33(10):1121-1128.
doi: 10.1007/s00380-018-1160-2. Epub 2018 Apr 11.

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

Masaaki Okutsu  1 , Takeshi Horio  2 , Hisataka Tanaka  2 , Maki Akiyama  2 , Niro Okimoto  2 , Toshiyuki Tsubouchi  3 , Kenji Kawajiri  3 , Yasuhiro Ohashi  4 , Satoru Sumitsuji  5 , Yuji Ikari  6
Affiliations

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

Masaaki Okutsu et al. Heart Vessels. 2018 Oct.

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.

Keywords: Computed tomography angiography; Intravascular ultrasound; No-reflow; Percutaneous coronary intervention; Plaque.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflict of interest to declare.

Figures

Fig. 1
Fig. 1
Representative images of CTA v-LAP (a–c) and IVUS AP (d). a Longitudinal coronary image and cross-sectional point by slab maximum intensity projection image. b Grayscale cross-sectional image. c Color map image and measurement of minimum CT density. Red area indicates < 0 HU density, i.e., v-LAP (arrowheads), orange area ≥ 0 and < 30 HU, yellow area ≥ 30 and < 50 HU, and green area ≥ 50 and < 250 HU. d Arrowheads indicate attenuated plaque on IVUS. CTA computed tomography angiography, HU Hounsfield units, IVUS intravascular ultrasound, IVUS AP attenuated plaque on IVUS, v-LAP very low attenuation plaque
See this image and copyright information in PMC

References

    1. Ito H, Tomooka T, Sakai N, Yu H, Higashino Y, Fujii K, Masuyama T, Kitabatake A, Minamino T. Lack of myocardial perfusion immediately after successful thrombolysis. A predictor of poor recovery of left ventricular function in anterior myocardial infarction. Circulation. 1992;85:1699–1705. doi: 10.1161/01.CIR.85.5.1699. - DOI - PubMed
    1. Piana RN, Paik GY, Moscucci M, Cohen DJ, Gibson CM, Kugelmass AD, Carrozza JP, Jr, Kuntz RE, Baim DS. Incidence and treatment of ‘no-reflow’ after percutaneous coronary intervention. Circulation. 1994;89:2514–2518. doi: 10.1161/01.CIR.89.6.2514. - DOI - PubMed
    1. Wu KC, Zerhouni EA, Judd RM, Lugo-Olivieri CH, Barouch LA, Schulman SP, Blumenthal RS, Lima JA. Prognostic significance of microvascular obstruction by magnetic resonance imaging in patients with acute myocardial infarction. Circulation. 1998;97:765–772. doi: 10.1161/01.CIR.97.8.765. - DOI - PubMed
    1. Morishima I, Sone T, Okumura K, Tsuboi H, Kondo J, Mukawa H, Matsui H, Toki Y, Ito T, Hayakawa T. 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. 2000;36:1202–1209. doi: 10.1016/S0735-1097(00)00865-2. - DOI - PubMed
    1. Yip HK, Chen MC, Chang HW, Hang CL, Hsieh YK, Fang CY, Wu CJ. Angiographic morphologic features of infarct-related arteries and timely reperfusion in acute myocardial infarction: predictors of slow-flow and no-reflow phenomenon. Chest. 2002;122:1322–1332. doi: 10.1378/chest.122.4.1322. - DOI - PubMed

MeSH terms