Infected pseudo coronary artery aneurysm (CAA) is extremely rare, and currently, there is no established treatment. We experienced a rare case of an infected pseudo CAA brought on due to a stent fracture. Following prolonged successful antimicrobial administration, which proved effective in successfully treating the patient, we performed coronary stent graft placement. Although a surgical procedure should fundamentally be the first course of action considered in such cases, when there are concerns as to the degree of invasiveness, our strategy represents a viable option.
Background:
The optimal site for measuring computed tomography (CT)-derived fractional flow reserve (FFR
CT
) to detect significant coronary artery disease (CAD) remains unknown. We investigated how diagnostic performance changes with FFR
CT
measurement site.
Methods and Results:
The diagnostic performance of FFR
CT
, measured 1–2 cm distal to the stenosis vs. a far-distal site, in detecting significant CAD with invasive fractional flow reserve ≤0.8 was evaluated in 254 diseased vessels from 146 patients with stable or suspected CAD diagnosed by coronary CT angiography. Receiver operating characteristic curve analysis revealed a significantly larger area under the curve for FFR
CT
measured 1–2 cm distal to the stenosis than at a far-distal site (0.829 vs. 0.791, respectively; P=0.0305). The rate of reclassification of positive FFR
CT
was 19% for measurements made 1–2 cm distal to the stenosis, and diagnostic accuracy for FFR
CT
0.71–0.80 improved from 36% to 58% (P=0.0052). Vessel-based diagnostic accuracy of FFR
CT
1–2 cm distal to the stenosis and at a far-distal site was 75% and 65%, respectively (P<0.0001), with corresponding sensitivity of 87% and 94% (P=0.0039), specificity of 60% and 29% (P<0.0001), a positive predictive value of 73% and 62% (P=0.028), and a negative predictive value of 78% and 79% (P=0.958).
Conclusions:
Our data suggest measuring FFR
CT
1–2 cm distal to the stenosis has better diagnostic performance for detecting physiologically significant CAD.
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