Koroner arter total oklüzyonu

Özet

Akut göğüs ağrısında koroner arterin tamamen tıkanması, beslediği miyokardda akut iskemi ve infarkt riski oluşturan kritik bir bulgudur. Koroner BT anjiyografi, opak lümen sütununun kesildiği yeri, varsa oklüzyona yol açan plağı ve distal damar yatağını gösterebilir. Distal damar kollaterallerle yeniden opaklaşabilir; bu görünüm oklüzyonu dışlamaz. Oklüzyonun gözden kaçması akut koroner olayın tanınmasını ve uygun acil değerlendirmeyi geciktirebilir.

Faz ve pencere

BTA tanısal

Kontrastlı koroner çekimde damar lümenindeki opak sütunun bir segmentte tamamen sonlanması ve segment boyunca lümen kontrastının görülmemesi aranır; distal damar opaklaşmıyorsa kesinti belirginleşir, kollateral dolum varsa daha geç veya daha az yoğun distal opasifikasyon görülebilir; aterosklerotik olguda plağın özellikleri ayrıca değerlendirilir.

BT perfüzyon

Kronik total oklüzyonda seçilmiş incelemelerde koroner BT anjiyografiye BT perfüzyon eklenerek koroner anatomiye ek olarak miyokard perfüzyonu da değerlendirilebilir.

Önerilen pencereler: Anjiyo (G 600 / M 150), Mediasten (G 350 / M 50).

BT bulguları

• Kontrast sütununun bir koroner segmentte tam kesilmesi; darlıkla karıştırmamak için lümenin devamlılığını çok düzlemli izlemde doğrula.
• Oklüzyonun proksimal ve distal sınırları, damar adı ve yan dal çıkışlarıyla ilişkisi.
• Distal damar opasifikasyonunun yokluğu veya kollaterallerden gelen daha zayıf distal kontrastlanma.
• Koroner BT anjiyografi kronik total oklüzyonda oklüzyon uzunluğunu, güdük özelliklerini, damar seyrini ve kollateral anatomiyi gösterebilir.
• Oklüzyonun distalindeki miyokardda hipoenhansman veya incelme eşlik edebilir; bu bulgular evrensel olarak bulunmaz.
• Yoğun kalsiyum, hareket veya düşük kontrast nedeniyle lümen izlenemiyorsa kesin oklüzyon yerine tanısal sınırlılığı belirt.

Ölçütler ve sınıflamalar

CAD-RADS 5

CAD-RADS 5: total oklüzyon

CAD-RADS 2.0 stenoz kategorisi 5

CAD-RADS 5, koroner arterde tam oklüzyon bulunduğunu ifade eder.

Normalde

Koroner BT anjiyografi koroner ağacın üç boyutlu anatomik görünümünü sağlayabilir. Şüpheli segmentte aynı damarın proksimal opasifikasyonunu, kesinti uzunluğunu ve distal yatağın opaklaşıp opaklaşmadığını; ayrıca karşı taraftan gelen kollateral damarları kıyaslayın.

Ayırıcı tanı

Ciddi subtotal stenoz

çok ince kontrast kanalı damar boyunca devam eder; gerçek total oklüzyonda lümen sütunu kesilmiştir.

Hareket artefaktı

kontur atlaması komşu kesitlerde veya farklı rekonstrüksiyon fazında kaybolabilir.

Kalsiyum blooming

kalsifiye plağın parlak kenarları opak lümeni örter; daha ince kernel ve damar eksenine dik kesitler değerlendirilir.

Koroner opasifikasyon yetersizliğinde kontrast zamanlaması teknik etkenlerden biri olabilir; hasta-özgü zamanlama, tepe koroner kontrastlanmayı sabit 5 saniyelik gecikmeden daha doğru öngörmüştür.

Koroner arter anomalisi veya doğuştan hipoplazi

beklenmedik damar seyri ve küçük çap tüm güzergâh boyunca izlenir; ani fokal lümen kesilmesi beklenmez.

Tuzaklar

• Distal segmentin kontrastlanması total tıkanmayı dışlamaz; proksimal oklüzyondan sonra kollateral dolum olasılığını koroner ağ boyunca izle.
• Bir iki kesitte görülen opasite kaybını oklüzyon sayma; eğrisel MPR ve ardışık ince kesitlerde kontrast sütununun gerçekten sonlandığını doğrula.
• Kronik oklüzyon segmentindeki yoğun kalsifikasyon ve daralan lümen, proksimal başlangıcın (stump) değerlendirmesini zorlaştırabilir; bu nedenle damarın tek bir kesitte değil, eğrisel MPR ile seyrinde izlenmesi gerekir.
• Akut miyokard infarktüsü tanısı konmuş bazı hastalarda geç gadolinyum tutulumlu kardiyak MR görüntülemesinde görünür miyokard hasarı saptanmayabilir; bu nedenle tutulumun yokluğu infarktüsü tek başına dışlamaz.
• Kronik total oklüzyon, koroner arterde tam oklüzyonun 3 aydan uzun sürmesi olarak tanımlanır.

Kendini dene

1. Koroner BT anjiyografide CAD-RADS 5 hangi bulguyu ifade eder?

   • Koroner arterde tam oklüzyon
   • Koroner arterlerde plak saptanmaması
   • En fazla %49 darlık
   • Yalnızca kalsiyum skoru yüksekliği
   Cevabı göster

   Koroner arterde tam oklüzyon. CAD-RADS 5, koroner arterde tam oklüzyon bulunduğunu ifade eder.

2. Kronik total oklüzyonda koroner BT anjiyografi hangi anatomik özelliği gösterebilir?

   • Oklüzyon uzunluğu ve güdük özellikleri
   • Koroner arterdeki kan akımının milisaniye cinsinden hızı
   • Miyokard hücrelerindeki troponin düzeyi
   • Koroner arter lümenindeki basınç gradyanı
   Cevabı göster

   Oklüzyon uzunluğu ve güdük özellikleri. Koroner BT anjiyografi, kronik total oklüzyonda oklüzyon uzunluğu ve güdük özellikleri gibi anatomik ayrıntıları gösterebilir.

Kaynaklar

Bu sayfadaki 36 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 14 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez, tıbbi tavsiye değildir. Metinler yapay zekâ desteğiyle yazıldı ve otomatik bir adımda kaynak alıntılarıyla karşılaştırıldı; bu bir tıbbi doğrulama değildir ve içerik uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.