Computed tomography angiography-guided percutaneous coronary intervention in chronic total occlusion
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The aim of this study is to investigate if dual-source computed tomography (DSCT) could guide the percutaneous coronary intervention (PCI) of chronic total occlusion (CTO).
We enrolled patients who were confirmed to have at least one native coronary artery CTO by DSCT before they underwent selective PCI in the period from December 2007 to October 2008. A CTO was defined as an obstruction of a native coronary artery with no luminal continuity. The CT-guided PCI procedure involved placing CT and fluoroscopic images side-by-side on the screen. DSCT images were analyzed for location, segment, plaque characteristics, calcification, and proximal lumen diameter of the CTO before PCI. The guidewire was advanced and manipulated under CT guidance. The PCI was carried out and the results were compared.
Seventy-four CTOs were assessed. PCI was successful in 57 cases of CTOs (77.0%). According to the results, CTOs were divided into two groups: successful-PCI and failed-PCI. All coronary artery paths of CTOs were clearly recognized by DSCT. In the successful-PCI group, soft plaques were detected much more often than those in the failed-PCI group, but fibrous and calcified plaques were seen more often in the failed-PCI group. Calcification severity in CTO segments showed a significant difference between the groups (P=0.014). Calcified plaques were detected in 20 (35.1%) lesions in the successful-PCI group. More than 70% of the failures were calcified plaques, of which there were two arc-calcified and one circular-calcified lesions. Occlusions were longer in the failed-PCI group than those in the successful-PCI group [(38.8±25.0) vs. (18.0±15.3) mm, respectively, P<0.01]. Fewer guidewires were used in the successful-PCI group compared with the failed-PCI group (1.7±1.0 vs. 2.5±0.9, respectively, P<0.01). The logistic regression analysis indicated that predictors of recanalization of CTOs included occlusion length (P=0.0035, risk ratio (RR)=0.93) and calcification severity (P=0.05, RR=0.27). Multi-linear trends analysis showed that the factors affecting procedural time were CTO location (P=0.0141) and occlusion length (P=0.0035).
DSCT could delineate the path of CTOs and characterize plaques. The outcomes of PCI were related to thrombolysis in myocardial infarction (TIMI) flow grade, CTO characteristics, severity of calcified plaques, and the length of occlusive segments. Occlusion length and calcification severity were independent predictors of CTOs. Occlusion length and CTO segments could also help to estimate the duration of interventional procedures.
Key wordsDual-source computed tomography (DSCT) Chronic total occlusion (CTO) Angiography Recanalization
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- Brodoefel, H., Reimann, A., Heuschmid, M., Tsiflikas, I., Kopp, A.F., Schroeder, S., Claussen, C.D., Clouse, M.E., Burgstahler, C., 2008. Characterization of coronary atherosclerosis by dual-source computed tomography and HU-based color mapping: a pilot study. European Radiology, 18(11):2466–2474. [doi:10.1007/s00330-008-1019-5]CrossRefPubMedGoogle Scholar
- Gai, L.Y., Li, P., Jin, Q.H., Yang, T.S., Chen, L., 2008. CT angiography guided chronic total coronary artery occlusion recannalization. Chinese Journal of Geriatric Heart Brain and Vessel Diseases, 5:331–333 (in Chinese).Google Scholar
- Leber, A.W., Knez, A., Becker, A., Nikolaou, K., Rist, C., Reiser, M., White, C., Steinbeck, G., Boekstegers, P., 2004. Accuracy of multidetector spiral computed tomography in identifying and differentiating the composition of coronary atherosclerotic plaques. Journal of the American College of Cardiology, 43(7):1241–1247. [doi:10.1016/j.jacc.2003.10.059]CrossRefPubMedGoogle Scholar
- Libby, P., Bonow, R.O., Mann, D.L., Zipes, D.P., 2007. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine, 8th Ed. Saunders, Philadelphia, PA, USA, p.492.Google Scholar
- Ng, W., Chen, W.H., Lee, P.Y., Lau, C.P., 2003. Initial experience and safety in the treatment of chronic total coronary occlusions with a new optical coherent reflectometry-guided radiofrequency ablation guidewire. The American Journal of Cardiology, 92(6):732–734. [doi:10.1016/S0002-9149(03)00841-5]CrossRefPubMedGoogle Scholar
- Olivari, Z., Rubartelli, P., Piscione, F., Ettori, F., Fontanelli, A., Salemme, L., Giachero, C., Di Mario, C., Gabrielli, G., Spedicato, L., et al., 2003. Immediate results and one-year clinical outcome after percutaneous coronary interventions in chronic total occlusions: data from a multicenter, prospective, observational study (TOAST-GISE). Journal of the American College of Cardiology, 41(10):1672–1678. [doi:10.1016/S0735-1097(03)00312-7]CrossRefPubMedGoogle Scholar
- Orlic, D., Stankovic, G., Sangiorgi, G., Airoldi, F., Chieffo, A., Michev, I., Montorfano, M., Carlino, M., Corvaja, N., Finci, L., et al., 2005. Preliminary experience with the frontrunner coronary catheter: novel device dedicated to mechanical revascularization of chronic total occlusions. Catheterization and Cardiovascular Interventions, 64(2): 146–152. [doi:10.1002/ccd.20272]CrossRefPubMedGoogle Scholar
- Puma, J.A., Sketch, M.H.Jr., Tcheng, J.E., Harrington, R.A., Phillips, H.R., Stack, R.S., Califf, R.M., 1995. Percutaneous revascularization of chronic total occlusion: an overview. Journal of the American College of Cardiology, 26(1):1–11. [doi:10.1016/0735-1097(95)001 56-T]CrossRefPubMedGoogle Scholar
- Safian, R.D., McCabe, C.H., Sipperly, M.E., McKay, R.G., Baim, D.S., 1988. Initial success and long term follow-up of transluminal andioplasty in chronic total versus conventional stenosis. The American Journal of Cardiology, 61(14):G23–G28. [doi:10.1016/S0002-9149 (88)80028-6]CrossRefGoogle Scholar
- Schroeder, S., Kopp, A.F., Baumbach, A., Meisner, C., Kuettner, A., Georg, C., Ohnesorge, B., Herdeg, C., Claussen, C.D., Karsch, K.R., 2007. Noninvasive plaque imaging using multislice detector spiral computed tomography. Seminars in Thrombosis and Hemostasis, 33(2):203–209. [doi:10.1055/s-2007-969035]CrossRefPubMedGoogle Scholar
- Srivatsa, S.S., Edwards, W.D., Boos, C.M., Grill, D.E., Sangiorgi, G.M., Garratt, K.N., Schwartz, R.S., Holmes, D.R.Jr., 1997. Histologic correlates of angiographic chronic total coronary artery occlusions: influence of occlusion duration on neovascular channel patterns and intimal plaque composition. Journal of the American College of Cardiology, 29(5):955–963. [doi:10.1016/S0735-1097(97)00035-1]CrossRefPubMedGoogle Scholar