Assessment of the presence and extent of coronary collateralization by coronary computed tomographic angiography in patients with total occlusions

  • Johannes Rieber
  • Tej N. Sheth
  • Eline A. Q. Mooyaart
  • Michael D. Shapiro
  • Javed Butler
  • Maros Ferencik
  • Thomas J. Brady
  • Volker Klauss
  • Udo Hoffmann
Original Paper


Coronary computed tomography angiography (CTA) may be helpful to manage patients with chronic coronary occlusions. The aim of this study was to determine the sensitivity and specificity of CTA to detect the presence and extent of coronary collaterals as compared to invasive coronary angiography (ICA). We retrospectively evaluated 26 patients who underwent both coronary CTA and ICA within 3 weeks and demonstrated a total coronary occlusion (TIMI grade 0) in one of the major coronary arteries. CTA was performed using a 64-slice multidetector CT. The presence, and extent of collateralization was assessed by two blinded observers using the Rentrop classification for ICA. CTA accurately identified the presence and location of all 26 total occlusions. The presence of any collaterals was accurately detected in 21/23 patients [sensitivity 91% (CI: 71–98%)] and the absence in three patients [specificity 100% (CI: 29%–100%)]. The sensitivity of coronary CTA to identify patients with collateralization increased from 91 to 94% (CI: 71–99%) and 100% (CI: 59–100%) for collaterals Rentrop grade 2 and 3 in ICA, respectively. Coronary CTA accurately detects the presence of any coronary collateralization in patients with total occlusions. Although CT technology is currently limited in the assessment of individual collaterals and smaller vessels, it may be helpful in the management of patients with total occlusions.


Total coronary occlusions Computed coronary angiography Coronary collaterals Coronary artery disease 



Confidence interval


Computed tomography


Computed tomography angiography


Hounsfield units


Invasive coronary angiograohy


Left anterior descending artery


Left circumflex artery


Multidetector computed tomography


Maximum intensity projection


Multiplanar reconstructions


Magnetic resonance imaging


Right coronary artery


Thrombolysis in myocardial infarction


Total occlusions


Conflict of interest and financial disclosure

Michael D. Shapiro, Javed Butler, and Maros Ferencik were supported in part by NIH grant 1 T32 HL076136-02. This project was in part supported by Siemens Medical Solutions, Forchheim, Germany.


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Copyright information

© Springer Science+Business Media, B.V. 2008

Authors and Affiliations

  • Johannes Rieber
    • 1
    • 2
  • Tej N. Sheth
    • 2
  • Eline A. Q. Mooyaart
    • 2
  • Michael D. Shapiro
    • 2
  • Javed Butler
    • 2
  • Maros Ferencik
    • 2
  • Thomas J. Brady
    • 2
  • Volker Klauss
    • 1
  • Udo Hoffmann
    • 2
    • 3
  1. 1.Department of Cardiology, Division of Internal MedicineUniversity of MunichMunichGermany
  2. 2.Department of RadiologyMassachusetts General Hospital, Harvard Medical SchoolBostonUSA
  3. 3.Harvard School of Public HealthBostonUSA

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