Chapter 3 Predicting Procedure Successful Rate and 1-Year Patency After
3.5 Conclusion
CTA may play a role in patient selection and may predict successful rate and 1-year patency after endovascular recanalization in patients with carotid CTOs. Patients with occlusions proximal to the clinoid segment of the ICA had a higher success rate after recanalization, less periprocedural major complications, and better patency rates as compared with those whose occlusion was located at, or distal to, the clinoid segment of the ICA.
doi:10.6342/NTU201603776 Note:
This part was published on Internal Journal of Cardiology 2016.
Lee CW, Lin YH, Liu HM, Wang YF, Chen YF, Wang JL. Predicting procedure successful rate and 1-year patency after endovascular recanalization for chronic carotid artery occlusion by CT angiography. International Journal of Cardiology. 2016 Jul 9;221:772-776.
39
Figure 3-1: Sub-classification of the 42 carotid chronic total occlusions in 41 patients and their outcomes.
doi:10.6342/NTU201603776 Figure 3-2: Kaplan-Meier Product Limit survival functional estimates for group A (red)
and group B (blue) patients after endovascular recanalization for chronic carotid artery occlusion.
41
Table 3-1: Demographics and clinical characteristics of all patients.
Variable Total (N=42) Group A
(N=23)
Group B (N=19)
P value
Age – yrs (SD) 65.45(9.96) 65.48(10.57) 65.42(9.46) 0.98
Male gender – no. (%) 34(81) 17(74) 17(89) 0.20
Right side –no. (%) 19(45) 11(48) 8(42) 0.71
Successful – no. (%) 29 (69) 12(52) 17(89) 0.0093**
Major complication – no. (%) 5(12) 5(22) 0(0) 0.03*
Patency (N=28) – no. (%) 17(61) 1(8) 16(100) <0.0001**
Stent number (N=29) – no. (SD) 2.25(1.40) 2.42(1.56) 2.12(1.31) 0.60
Symptomatic – no. (%) 32(76) 17(74) 15(79) 0.70
Coronary heart disease – no. (%) 26(62) 13(57) 13(68) 0.43
Diabetes – no. (%) 12(29) 10(43) 2(11) 0.0186*
Hypertension – no. (%) 32(76) 18(78) 14(74) 0.73
Hyperlipidemia – no. (%) 25(60) 13(56) 12(63) 0.66
Cancer – no. (%) 9(21) 4(17) 5(26) 0.48
Smoking – no. (%) 17(40) 9(39) 8(42) 0.85
The P-value was obtained using the chi-square test for categorical data, and the t-test for continuous data.
doi:10.6342/NTU201603776 Table 3-2: Odds ratio for clinical predictors of stent occlusion in technically successful
patients (N = 28).
Variable Odds ratio (CI) P-value
Group effect 253.00(9.44-6777.47) <0.001**
Old age (age > 55) 0.36(0.049-2.59) 0.30
Male gender 0.60(0.072-5.03) 0.64
Right side 0.94(0.21-4.29) 0.93
Symptomatic 1.11(0.21-6.01) 0.90
Coronary heart disease 0.73(0.15-3.65) 0.70
Diabetes 13.13(1.92-89.52) 0.004*
Hypertension 1.88(0.29-11.97) 0.50
Hyperlipidemia 1.87(0.37-9.63) 0.45
Cancer 0.24(0.02-2.41) 0.20
Smoking 2.00(0.41-9.71) 0.39
The P-values were obtained by chi-square test.
43
Table 3-3: Univariable non-parametric survival analysis of clinical predictors for one-year stent patency.
Variable P-value
Group effect <0.001**
Old age (age > 5) 0.8258
Gender 0.5457
Right side 0.8389
Diabetes 0.0553
Coronary heart disease 0.3141
Hypertension 0.8723
Symptomatic 0.7853
Hyperlipidemia 0.3572
Smoking 0.4119
Cancer 0.3895
Note: Wilcoxon test was used.
doi:10.6342/NTU201603776
Chapter 4 Future Work
Hybrid CTA provides an opportunity for more accurate detection and diagnosis of vascular diseases in head and neck. It can potentially be used in diseases other than dural arteriovenous fistula and carotid occlusion, and may improve visualization and 3D reconstruction of vessels after successful bone removal.
Rapid processing software is required for quick and accurate diagnosis in emergent situations. The prototype software has to be converted into robust software, so that the usage can be easier and more popular.
For vascular lesions in or near the bones, computer-assisted detection (CAD) is potentially difficult. After successful removal of bone and calcification by hybrid subtraction, CAD of vascular lesions can be done easier since there is no need for segmentation. Vascular caliber analysis can also be done easily. Preservation of image quality away from bones in hybrid CTA would not affect the performance of CAD in non-bone area.
Dual-energy CT is also a good tool for bone removal in CTA [59, 60]. However, there is still no study comparing the image quality and radiation dose between subtraction CTA and dual-energy CTA. With satisfactory registration and hybrid subtraction, CTA done by simple multi-detector row CT is still valuable since it is more widely used. Not all cases can receive dual-energy CTA. A bone removal technique for
45
usual CT scanner is still required. After establishment of dual-energy CT, further comparison can be implemented.
doi:10.6342/NTU201603776
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