RESUMO
BACKGROUND: We sought to compare the degree of maximal stenosis and the rate of invasive coronary angiography (ICA) recommendations in patients who underwent coronary CT angiography (CCTA) with photon-counting detector CT (PCD-CT) versus those who underwent CCTA with whole heart coverage energy-integrating detector CT (EID-CT). METHODS: In our retrospective single-center study, we included consecutive patients with suspected CAD who underwent CCTA performed with either PCD-CT or a 280-slice EID-CT. The degree of coronary stenosis was classified as no CAD, minimal (1-24 â%), mild (25-49 â%), moderate (50-69 â%), severe stenosis (70-99 â%), or occlusion. RESULTS: A total of 812 consecutive patients were included in the analysis, 401 patients scanned with EID-CT and 411 patients with PCD-CT (mean age: 58.4 â± â12.4 years, 45.4 â% female). Despite the higher total coronary artery calcium score (CACS) in the PCD-CT group (10 [interquartile range (IQR) â= â0-152.8] vs 1 [IQR â= â0-94], p â< â0.001), obstructive CAD was more frequently reported in the EID-CT vs PCD-CT group (no CAD: 28.7 â% vs 26.0 â%, minimal: 23.2 â% vs 30.9 â%, mild: 19.7 â% vs 23.4 â%, moderate: 14.5 â% vs 9.7 â%, severe: 11.5 â% vs 8.5 â% and occlusion: 2.5 â% vs 1.5 â%, respectively, p â= â0.025). EID-CT was independently associated with downstream ICA (OR â= â2.76 [95%CI â= â1.58-4.97] p â< â0.001) in the overall patient population, in patients with CACS<400 (OR â= â2.18 [95%CI â= â1.13-4.39] p â= â0.024) and in patients with CACS≥400 (OR â= â3.83 [95%CI â= â1.42-11.05] p â= â0.010). CONCLUSION: In patients who underwent CCTA with PCD-CT the number of subsequent ICAs was lower as compared to patients who were scanned with EID-CT. This difference was greater in patients with extensive coronary calcification.
Assuntos
Angiografia por Tomografia Computadorizada , Tomografia Computadorizada por Raios X , Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Masculino , Angiografia Coronária , Estudos Retrospectivos , Constrição Patológica , Estudos Prospectivos , Valor Preditivo dos Testes , Encaminhamento e Consulta , Imagens de FantasmasRESUMO
PURPOSE: We aimed to evaluate the long-term outcome of carotid endarterectomy (CEA) and carotid artery stenting (CAS) in patients who underwent both procedures on different sides. METHODS: In this single-center retrospective study (2001-2019), 117 patients (men, N = 78; median age at CEA, 64.4 [interquartile range {IQR}, 57.8-72.2] years; median age at CAS, 68.8 [IQR, 61.0-76.0] years) with ≥50% internal carotid artery stenosis who had CEA on one side and CAS on the other side were included. The risk of restenosis was estimated by treatment adjusted for patient and lesion characteristics. RESULTS: Neurological symptoms were significantly more common (41.9% vs 16.2%, P<0.001) and patients had a significantly shorter mean duration of smoking (30.2 [standard deviation {SD}, 22.2] years vs 31.8 [SD, 23.4] years, P<0.001), hypertension (10.1 [SD, 9.8] years vs 13.4 [SD, 9.1] years, P<0.001), hyperlipidemia (3.6 [SD, 6.6] years vs 5.0 [SD, 7.3] years, P = 0.001), and diabetes mellitus (3.9 [SD, 6.9] years vs 5.7 [SD, 8.9] years, P<0.001) before CEA compared to those before CAS. While the prevalence of heavily calcified stenoses on the operated side (25.6% vs 6.8%, P<0.001), the incidence of predominantly echogenic/echogenic plaques (53.0% vs 70.1%, P = 0.011) and suprabulbar lesions (1.7% vs 22.2%, P<0.001) on the stented side was significantly higher. Restenosis rates were 10.4% at 1 year, 22.3% at 5 years, and 33.7% at the end of the follow-up (at 11 years) for CEA, while these were 11.4%, 14.7%, and 17.2%, respectively, for CAS. Cox regression analysis revealed a significantly higher risk of restenosis (hazard ratio [HR], 1.80; 95% confidence interval [CI], 1.05-3.10; P = 0.030) for CEA compared to that for CAS. After adjusting for relevant confounding factors (smoking, hypertension, diabetes mellitus, calcification severity, plaque echogenicity, and lesion location), the estimate effect size materially did not change, although it did not remain statistically significant (HR, 1.85; 95% CI, 0.95-3.60; P = 0.070). CONCLUSION: Intra-patient comparison of CEA and CAS in terms of restenosis tilts the balance toward CAS.
