OBJECTIVE: 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). METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
OBJECTIVE: 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). METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
Authors: H Brodoefel; A Reimann; M Heuschmid; I Tsiflikas; A F Kopp; S Schroeder; C D Claussen; M E Clouse; C Burgstahler Journal: Eur Radiol Date: 2008-05-20 Impact factor: 5.315
Authors: S S Srivatsa; W D Edwards; C M Boos; D E Grill; G M Sangiorgi; K N Garratt; R S Schwartz; D R Holmes Journal: J Am Coll Cardiol Date: 1997-04 Impact factor: 24.094
Authors: Alexander W Leber; Andreas Knez; Alexander Becker; Christoph Becker; Franz von Ziegler; Konstantin Nikolaou; Carsten Rist; Maximilian Reiser; Carl White; Gerhard Steinbeck; Peter Boekstegers Journal: J Am Coll Cardiol Date: 2004-04-07 Impact factor: 24.094
Authors: J A Puma; M H Sketch; J E Tcheng; R A Harrington; H R Phillips; R S Stack; R M Califf Journal: J Am Coll Cardiol Date: 1995-07 Impact factor: 24.094
Authors: Islam Abdelmoneim; Ayman Sadek; Mohamed Ahmed Mosaad; Ibrahim Yassin; Yasser Radwan; Khalid Shokry; Ahmed Magdy; Mohammed Yasser Elsherbeny; Abdelrahman Ibrahim Abushouk Journal: Int J Cardiovasc Imaging Date: 2018-06-08 Impact factor: 2.357
Authors: Andrew J Klein; Michael T Tomkowiak; Karl K Vigen; Timothy A Hacker; Michael A Speidel; Michael S Vanlysel; Nehal Shah; Amish N Raval Journal: Catheter Cardiovasc Interv Date: 2012-10-24 Impact factor: 2.692