title: Association of target lesion characteristics evaluated by coronary computed tomography angiography and plaque debris distal embolization during percutaneous coronary intervention.
abstract: BACKGROUND
  The slow-flow or no re-flow phenomenon has been associated with distal embolization, especially of plaque debris, and with unfavorable clinical outcomes. Therefore, we examined the association between the coronary computed tomography angiography (CCTA) findings of the target lesion and distal embolization during percutaneous coronary intervention (PCI). METHODS AND RESULTS: Consecutive patients (n=55: 18 unstable angina, 19 stable effort angina, 18 silent ischemia) who underwent PCI with a filter-type distal protection device after evaluation of the target lesion by CCTA were analyzed. CCTA examined low-attenuation plaque (LAP), positive remodeling (PR), and ring-like enhancement of the target lesion. Distal embolization of thrombus and plaque debris was evaluated by pathological examination of material collected in the filter.Any distal embolization and distal embolization of plaque debris were respectively detected in 75% and 0% of patients with LAP or PR alone, in 95% and 17% of patients with both LAP and PR, and in 100% and 27% of patients with all of LAP, PR and ring-like enhancement. The sensitivity and specificity to predict plaque debris embolization by having both findings of LAP and PR was 100% and 46%, respectively.
  
  
  CONCLUSIONS
  The CCTA findings of the target lesion were associated with distal embolization and were very sensitive for predicting plaque debris embolization.
authors.affiliation: Cardiovascular Division, Osaka Police Hospital.
authors.forename: Mayu
authors.initials: M
authors.lastname: Nishio
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Ueda
authors.forename: Koshi
authors.initials: K
authors.lastname: Matsuo
authors.forename: Masahiko
authors.initials: M
authors.lastname: Tsujimoto
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Hao
authors.forename: Mitsutoshi
authors.initials: M
authors.lastname: Asai
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Nemoto
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Wada
authors.forename: Akio
authors.initials: A
authors.lastname: Hirata
authors.forename: Ayaka
authors.initials: A
authors.lastname: Murakami
authors.forename: Kazunori
authors.initials: K
authors.lastname: Kashiwase
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Kodama
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D004617:Embolism / Q000000981:diagnostic imaging / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging / Q000601:surgery; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed