Graft Fungal Infection After Ascending Aorta Replacement.

Aortic graft infection is an uncommon but highly fatal complication. Correct diagnosis and timely treatment are somewhat challenging. This study presents a case report of successful recognition and treatment of this complication.

Quantitative coronary computed tomography angiography assessment of chronic total occlusion percutaneous coronary intervention.

Background: Morphological and clinical characteristics are widely used to predict the success of percutaneous coronary intervention (PCI) in patients with chronic total occlusion (CTO). However, the impact of quantitative characteristics derived from coronary computed tomography angiography (CCTA) on guidewire crossing and PCI success is still unclear. This study aimed to explore the association between these quantitative characteristics and the difficulty of PCI for CTO. Methods: A total of 207 CTO lesions from 201 patients (84.6% male; mean age 58.9 years) with pre-procedural CCTA scans who had undergone PCI for CTO were retrospectively enrolled in this case-control study. A semi-automated CCTA plaque-analysis software was adopted to obtain the total plaque volume and volume of each component according to the Hounsfield Unit (HU) value, including dense calcium (>351 HU), fibrous (131-350 HU), fibrofatty (76-130 HU), and necrotic core (-30-75 HU) tissue. Differences in the quantitative characteristics of the CTO lesions were compared between: (I) the group of lesions with successful guidewire crossing (≤30 min) and the group with failed guidewire crossing (≤30 min); (II) the group of lesions with procedural success [defined as achieving residual stenosis of <30% and a grade 3 thrombolysis in myocardial infarction (TIMI) flow] and the group with procedural failure. Logistic regression was used to explore the association of quantitative characteristics with successful guidewire crossing in ≤30 min and procedural success. Results: A total of 131 (63.3%) lesions of 126 patients achieved successful guidewire crossing in ≤30 min and 157 (75.8%) lesions of 152 (75.6%) patients achieved procedural success. Quantitative characteristics such as occlusion length, plaque volume, volume of dense calcium, and fibrous and fibrofatty tissue showed significant differences between the groups of lesions with successful guidewire crossing in ≤30 min and with failed guidewire crossing in ≤30 min, as well as the groups of lesions with procedural success and with procedural failure. According to the results of logistic regression analysis, lower percentages of dense calcium [odds ratio (OR) =0.970, 95% confidence interval (CI): 0.950 to 0.991; P=0.004] and fibrous (OR =0.970, 95% CI: 0.949 to 0.992; P=0.007) tissue and higher percentage of necrotic core tissue (OR =1.018, 95% CI: 1.005 to 1.030; P=0.005) were significantly associated with successful guidewire crossing in ≤30 min. Decreased percentages of dense calcium (OR =0.969; 95% CI: 0.949 to 0.989; P=0.002) and fibrous tissue (OR =0.966, 95% CI: 0.944 to 0.990; P=0.005) and higher percentage of necrotic core tissue (OR =1.022, 95% CI: 1.008 to 1.036; P=0.002) were associated with procedural success. After adjusting for cardiovascular risk factors, the percentages of dense calcium, fibrous, and necrotic core tissue were still associated with successful guidewire crossing in ≤30 min, and the quantitative parameters showed consistent association with procedural success. Conclusions: Quantitative characteristics derived from CCTA for CTO are associated with successful guidewire crossing and procedural success of PCI.

Inclusion of quantitative high-density plaque in coronary computed tomographic score system to predict the time of guidewire crossing chronic total occlusion.

OBJECTIVE: This study aimed to establish a new scoring system that includes histological quantitative features derived from coronary computed tomographic angiography (CCTA) to predict the efficiency of chronic total occlusion percutaneous coronary intervention (CTO-PCI). METHODS: This study analyzed clinical, morphological, and histological characteristics of 207 CTO lesions in 201 patients (mean age 60.0 [52.0-65.0] years, 85% male), which were recruited from two centers. The primary endpoint was a guidewire successfully crossing the lesions within 30 m. The new predictive model was generated by factors that were determined by multivariate analysis. The CCTA plaque (CTAP) score that included a quantitative plaque characteristic was developed by assigning an appropriate integer score to each independent predictor, then summing all points. In addition, the CTAP score was compared with other predictive scores based on CCTA. RESULTS: The endpoint was achieved in 63% of the lesions. The independent predictors included previous CTO-PCI failure, the proximal blunt stump, proximal side branch, distal side branch, occluded segment bending > 45°, and high-density plaque volume (fibrous volume + calcified volume) ≥ 19.9 mm3. As the score increased from 0 to 5, the success rate of the guidewire crossing within 30 m decreased from 96 to 0%. Comparing the CTAP score with other predictive scores, the CTAP score showed the highest discriminant power (c-statistic = 0.81 versus 0.73-0.77, p value 0.02-0.07). The CTAP score showed similar results for procedural success. CONCLUSION: The CTAP score efficiently predicted the guidewire crossing efficiency and procedural success. KEY POINTS: • An increase in high-density plaque volume (fibrous + dense calcium) was more probable to reduce the efficiency of crossing and lead to procedural failure. • The new prediction scoring system with the addition of the quantitative characteristics of plaques had an improved predictive ability compared with the traditional prediction scoring system.