A milestone in prediction of the coronary artery dimensions from the multiple linear regression equation

Bachground /aim Coronary artery imaging is one of the most commonly used diagnostic methods. We aimed to investigate whether there is a correlation between left main coronary artery (LMCA), left anterior descending artery (LAD) and left circumflex artery (LCx) artery dimensions in normal cases and a possibility to express the coronary dimensions by multiple linear equations. Materials and methods Images of coronary angiograms of 925 normal cases selected from 3855 cases made up the study population (515 men and 410 women; age range, 30–75 years). The mean age of the patients was 55.50 ± 6.49 years. The mean body mass index was 24.79 ± 1.45 kg/m2 (range, 31.30–21.26 kg/m2). The mean dimensions of LMCA, LAD and LCx were 4.18 ± 0.65 mm, 3.22 ± 0.63 mm and 3.07 ± 0.65 mm, respectively. Correlation between LMCA, LAD and LCx diameters was investigated. Multiple linear regression analysis was used to develop a model to elucidate the relationship between LMCA, LAD and LCx diameters. Results There was a strong correlation between LMCA dimensions and LAD and LCx dimensions (r = 0.526**, p < 0.001* and r = 0.469**, p < 0.001*, respectively). The positive correlation indicated that a regression analysis can be carried out by incorporating the measurements. Coronary artery dimensions were gender specific. Conclusion The present study explored the possibility of explaining the relationship with the LMCA and its branches by multiple linear equations, which may then be used to estimate the reference diameter of a stenosed coronary artery when the other two arteries are normal.

Outcomes of carotid artery stenting in patients with symptomatic and asymptomatic carotid artery stenosis.

OBJECTIVE: Carotid endarterectomy is superior to medical therapy in patients with significant extracranial carotid artery stenosis. This modality of treatment has its own complications. The principal objective of this study is to assess efficacy, feasibility and outcomes of carotid artery stenting in both symptomatic and asymptomatic carotid artery stenosis. METHODS: Our study is a retrospective analysis of 45 consecutive patients with 56 lesions who underwent carotid angioplasty with stenting from January 2000 to June 2007 for carotid artery stenosis of more than 70%. All patients underwent detailed neurological examination and carotid Doppler evaluation by using Sonos 5500. Computed tomography of brain was done in those patients who were symptomatic in the past. RESULTS: The mean age of the study population was 65 +/- 9.2 years. There were 34 (79%) patients with coronary artery disease and out of them 31 (68%) patients had undergone coronary artery bypass grafting. All patients with common carotid artery, 13 (81%) patients with right internal carotid stenosis and 12 (66%) patients with left internal carotid artery stenosis had ostioproximal stenosis. Contralateral lesion was found in 9 patients and 2 patients had total occlusion. There were no post-procedural neurological events. Only one patient died in our study population due to non-cerebral cause. CONCLUSION: Carotid artery stenting is a safe procedure. The 30 days' outcomes are similar in both symptomatic and asymptomatic patients with significant carotid artery stenosis.

Left subclavian artery aneurysm presenting as pseudocoarctation on CT angiogram.

A 36-year-old, hypertensive gentleman with aneurysm of left subclavian artery revealed CT picture suggestive of left subclavian aneurysm with psuedocoarctation of aorta. Cardiac catheterization showed no gradient across the psuedocoarct segment.

Accuracy of 64-slice coronary CT angiography in predicting percentage diameter stenosis.

OBJECTIVE: Aim of our study was to evaluate the diagnostic accuracy of 64-slice CT coronary angiogram in measuring the percentage diameter stenosis compared to invasive angiography. METHODS AND RESULTS: 100 consecutive patients with more than 50% stenosis in at least one major coronary artery measured by 64-slice CT angiogram were included in the study. Patients with atrial fibrillation, history of allergy to contrast agent, acute coronary syndrome, renal insufficiency, history of previous coronary bypass surgery or percutaneous transluminal coronary stent, heart rate more than 70 per minute at the time of scan in spite of beta-blocker therapy, and calcium score >2000 Agaston units were not included in the study. 15-segment American Heart Association classification was used, and segments were compared using qualitative angiography. 192 segments (12.80%) could not be assessed due to poor image quality. The major cause for poor image quality was dense calcification precluding the luminal assessment (60.42%). Comparing the maximal percentage diameter stenosis by 64-slice CT versus invasive angiogram, the Spearman correlation coefficient between the two modalities was 0.788 and p value was <0.001. Bland-Altman analysis showed a mean difference in percentage stenosis of 2.1 +/- 16.22%. A total of 91.97% (401 of 436) of segments were within 1.96 standard deviations. CONCLUSION: This study shows that 64-slice CT coronary angiogram is accurate in detecting percentage diameter stenosis compared to coronary angiogram if the image quality is good. Calcifications and motion artifacts are the main culprits of poor image quality.