“…At coronary CTA, diffuse disease is defined as a long coronary segment (≥20 mm) with angiographic irregularities. Localized disease, as well as focal lesion, was characterized as a lesion length <20 mm ( 16 ).…”
Background
The clinical value of pericoronary adipose tissue in assessing Takayasu arteritis (TAK) with coronary artery involvement (CAI) is yet to be determined. The purpose of this study was to investigate the characteristics of pericoronary fat attenuation index (FAI) derived from coronary computed tomography angiography (CTA) in patients with TAK.
Methods
This is a retrospective study involving enrollment of 111 consecutive patients (mean age, 33.92±12.48 years) who were diagnosed as TAK, of which 52 patients had coronary artery involvement (TAK-CAI) and 59 patients without coronary artery involvement (TAK-nonCAI). Based on the extent of coronary artery lesion, the TAK-CAI group was further classified into localized group (n=25) and diffused group (n=27). Furthermore, patients with TAK were divided into active group (n=33) and inactive group (n=78). Meanwhile, 51 gender-matched individuals with normal appearance in coronary CTA examination were enrolled as the control group. The pericoronary FAI was quantitatively evaluated on each coronary CTA examination groups. The diagnostic value of pericoronary FAI was determined using the area under the curve (AUC) of the receiver operating characteristic.
Results
A higher pericoronary FAI was found in TAK-nonCAI group than control group with normal coronary arteries (P<0.001). Multivariate analysis showed that the FAI is an independent risk factor for coronary involvement in TAK patients [odds ratio (OR): 1.23, 95% confidence interval (CI): 1.13–1.35, P<0.001]. With the best cut-off value of −86.50, the pericoronary FAI identified coronary involvement with 67.8% sensitivity and 74.5% specificity (AUC: 0.794, 95% CI: 0.713–0.875, P<0.001). Multivariate analysis showed that the pericoronary FAI is an independent risk factor for determination of active TAK patients (OR: 1.57, 95% CI: 1.25–1.97, P<0.001). With the best cut-off value of −79.50, the pericoronary FAI identified active inflammation with 93.9% sensitivity and 74.4% specificity (AUC: 0.911, 95% CI: 0.860–0.962, P<0.001).
Conclusions
Coronary CTA-derived FAI is significantly increased in patients with TAK and can be used as a reliable biomarker to distinguish TAK patients from those with normal coronary arteries, and determine the extent of TAK inflammation.
“…At coronary CTA, diffuse disease is defined as a long coronary segment (≥20 mm) with angiographic irregularities. Localized disease, as well as focal lesion, was characterized as a lesion length <20 mm ( 16 ).…”
Background
The clinical value of pericoronary adipose tissue in assessing Takayasu arteritis (TAK) with coronary artery involvement (CAI) is yet to be determined. The purpose of this study was to investigate the characteristics of pericoronary fat attenuation index (FAI) derived from coronary computed tomography angiography (CTA) in patients with TAK.
Methods
This is a retrospective study involving enrollment of 111 consecutive patients (mean age, 33.92±12.48 years) who were diagnosed as TAK, of which 52 patients had coronary artery involvement (TAK-CAI) and 59 patients without coronary artery involvement (TAK-nonCAI). Based on the extent of coronary artery lesion, the TAK-CAI group was further classified into localized group (n=25) and diffused group (n=27). Furthermore, patients with TAK were divided into active group (n=33) and inactive group (n=78). Meanwhile, 51 gender-matched individuals with normal appearance in coronary CTA examination were enrolled as the control group. The pericoronary FAI was quantitatively evaluated on each coronary CTA examination groups. The diagnostic value of pericoronary FAI was determined using the area under the curve (AUC) of the receiver operating characteristic.
Results
A higher pericoronary FAI was found in TAK-nonCAI group than control group with normal coronary arteries (P<0.001). Multivariate analysis showed that the FAI is an independent risk factor for coronary involvement in TAK patients [odds ratio (OR): 1.23, 95% confidence interval (CI): 1.13–1.35, P<0.001]. With the best cut-off value of −86.50, the pericoronary FAI identified coronary involvement with 67.8% sensitivity and 74.5% specificity (AUC: 0.794, 95% CI: 0.713–0.875, P<0.001). Multivariate analysis showed that the pericoronary FAI is an independent risk factor for determination of active TAK patients (OR: 1.57, 95% CI: 1.25–1.97, P<0.001). With the best cut-off value of −79.50, the pericoronary FAI identified active inflammation with 93.9% sensitivity and 74.4% specificity (AUC: 0.911, 95% CI: 0.860–0.962, P<0.001).
Conclusions
Coronary CTA-derived FAI is significantly increased in patients with TAK and can be used as a reliable biomarker to distinguish TAK patients from those with normal coronary arteries, and determine the extent of TAK inflammation.
“…It can occur in distal coronary arteries, descending branches, side branches, and bifurcations, and its complexity results in a poorer outcome compared with focal lesions. The use of DES alone not only has long-term metal irritation and a higher risk of late thrombosis, but also the placement of long DES stents (≥60 mm) can lead to an increased incidence of adverse events, resulting in poorer outcomes in diffuse coronary artery disease, whereas the combination of DEB and DES can limit the length of the stent to a certain extent, reduce stent loading, and decrease the incidence of the aforementioned adverse events, providing a favorable treatment for diffuse coronary artery disease ( 82 , 83 ).…”
Section: The Application Of Drug Eluting Balloon In Arterial Circulat...mentioning
The arterial circulatory system diseases are common in clinical practice, and their treatment options have been of great interest due to their high morbidity and mortality. Drug-eluting balloons, as a new type of endovascular interventional treatment option, can avoid the long-term implantation of metal stents and is a new type of angioplasty without stents, so drug-eluting balloons have better therapeutic effects in some arterial circulatory diseases and have been initially used in clinical practice. In this review, we first describe the development, process, and mechanism of drug-eluting balloons. Then we summarize the current studies on the application of drug-eluting balloons in coronary artery lesions, in-stent restenosis, and peripheral vascular disease. As well as the technical difficulties and complications in the application of drug-eluting balloons and possible management options, in order to provide ideas and help for future in-depth studies and provide new strategies for the treatment of more arterial system diseases.
“…Although further data are required, recent studies used the criteria of delta-FFR of ≥0.05 and delta-NHPR of ≥0.03 across the relatively short segment (10 to 20 mm) to define a physiologically focal lesion. 83 If the pressure step-up is gradual throughout the target vessel, local treatment with stenting is unlikely to improve the patient’s physiologic and clinical prognosis. 75 , 76 Figure 4 Concept of 2-Dimensional Characterization of Coronary Atherosclerotic Disease Patterns The 2-dimensional characterization of coronary atherosclerotic disease consists of physiologic distribution (predominant focal vs diffuse) and physiologic local severity (major vs no major gradient).…”
Section: Longitudinal Vessel Analysis and Procedural Planningmentioning
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