Effect of preoperative evaluation by multidetector computed tomography in percutaneous coronary interventions of chronic total occlusions

Ueno, Koji; Kawamura, Akio; Onizuka, Takeshi; Kawakami, Takashi; Nagatomo, Yuji; Hayashida, Kentaro; Yuasa, Shinsuke; Maekawa, Yuichiro; Anzai, Toshihisa; Jinzaki, Masahiro; Kuribayashi, Sachio; Ogawa, Satoshi

doi:10.1016/j.ijcard.2010.10.026

Cited by 9 publications

(7 citation statements)

References 28 publications

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“…Rolf et al could show that CCTA prior to percutaneous coronary intervention (PCI) could significantly improve success rates of the intervention in 30 patients [ 43 ]. Three-dimensional images derived from CCTA guided the advance of the guide wire during the intervention and could thus lead to a success rate of 90% versus 63% in the control group without CT. Another study with 100 patients could demonstrate significantly fewer complications, such as coronary perforations, but no improvement in success [ 44 ]. Severe coronary calcification seems to be an independent predictor of failure of revascularization of a CTO lesion [ 45 ].…”

Section: Imaging Of Coronary Plaques and Stenosesmentioning

confidence: 99%

Coronary CT Angiography in Managing Atherosclerosis

Eckert

Schmidt

Magedanz

et al. 2015

IJMS

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Invasive coronary angiography (ICA) was the only method to image coronary arteries for a long time and is still the gold-standard. Technology of noninvasive imaging by coronary computed-tomography angiography (CCTA) has experienced remarkable progress during the last two decades. It is possible to visualize atherosclerotic lesions in the vessel wall in contrast to “lumenography” performed by ICA. Coronary artery disease can be ruled out by CCTA with excellent accuracy. The degree of stenoses is, however, often overestimated which impairs specificity. Atherosclerotic lesions can be characterized as calcified, non-calcified and partially calcified. Calcified plaques are usually quantified using the Agatston-Score. Higher scores are correlated with worse cardiovascular outcome and increased risk of cardiac events. For non-calcified or partially calcified plaques different angiographic findings like positive remodelling, a large necrotic core or spotty calcification more frequently lead to myocardial infarctions. CCTA is an important tool with increasing clinical value for ruling out coronary artery disease or relevant stenoses as well as for advanced risk stratification.

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Section: Imaging Of Coronary Plaques and Stenosesmentioning

confidence: 99%

Coronary CT Angiography in Managing Atherosclerosis

Eckert

Schmidt

Magedanz

et al. 2015

IJMS

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“…22 Overall, patients had similar procedural time and contrast volume to other previous studies. 12,23 Among the CTO-diagnosed patient group, statistically significant differences between CCTA-positive and CCTA-negative patients were not seen with regard to procedural characteristics. However, there was a favorable trend toward reduction in contrast use, procedure time, and radiation exposure both in the primary analysis and across multiple exploratory analyses as described.…”

Section: Discussionmentioning

confidence: 86%

“…Studies have demonstrated that CCTA accurately characterizes CTO when the presence of such an occlusion has already been established by CAG. 5 As a guide to percutaneous coronary intervention (PCI) of CTO, CCTA has been shown to not only predict outcomes, [6][7][8] but improve procedural success rate, 9,10 clinical outcomes, 11,12 and help limit complications. While assessment of anatomic features germane to successful CTO-PCI may be difficult to assess by conventional CAG, 8 CCTA provides reliable three-dimensional measurement of length and calcification of occluded segments.…”

mentioning

confidence: 99%

Efficacy of Coronary Computed Tomography Angiography for the De Novo Detection of Chronic Total Occlusion Prior to Coronary Angiography: A Preliminary and Retrospective Study

et al. 2020

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Coronary computed tomography angiography (CCTA) offers high-resolution anatomic characterization of the coronary vasculature but may be suboptimal for lesions dependent on real-time visualization of flow including chronic total occlusion (CTO). In CTOs, heavy calcification and distal vessel opacification from collateralization may confound luminal assessment. Several studies have examined the role of CCTA in characterizing known CTOs to guide percutaneous coronary intervention (PCI). However, the efficacy of CCTA in the de novo diagnosis of CTOs prior to coronary angiography (CAG) has not been demonstrated. A total of 233 consecutive patients who presented for CAG within a 3-month period of having CCTA were retrospectively reviewed. Those patients with prior diagnosis of CTO or prior bypass of the occluded vessels were excluded. Sensitivity and specificity analysis of CCTA in identifying CTOs using CAG as the gold standard was performed. The prevalence of CTO was 21.11% in the population that met criteria for analysis (n = 199). The sensitivity of CCTA in predicting CTO was 57.1%, while the specificity was 96.8%. The positive predictive value and negative predictive value of CCTA in detection of CTO were 82.8 and 89.4%, respectively. Our study shows that CCTA has excellent specificity but poor sensitivity in the detection of CTO thus limiting its clinical use in de novo diagnosis. Further studies to determine the effect of de novo CTO diagnosis on clinically important procedural factors, such as radiation exposure, contrast use, and need for repeat procedures, are warranted and may implicate a role for CCTA in this setting.

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“…Coronary CT angiography (CTA) provides high-quality noninvasive images of the heart, great vessels and coronary vasculature [8,9].…”

Section: Introductionmentioning

confidence: 99%

‘Triple-rule-out’ CT angiography for clinical decision making and early triage of acute chest pain patients: use of 320-multislice CT angiography

Eltabbakh

Dawoud

Langer

et al. 2019

Egypt J Radiol Nucl Med

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Background: In our study, we aimed to estimate utility of TRO CTA to guide clinical decision in acute chest pain patients with intermediate risk to acute coronary syndrome (ACS) in the emergency department.Methods and material: Our study population included 45 acute chest pain patients with intermediate-risk ACS. All these patients had done TRO CTA to access any pathological conditions in the coronary artery, pulmonary artery, aorta and thoracic diseases that may be the cause of their complaint. Follow-up was done in all patients for 60 days.Results: Among the 45 patients, we were able to discharge 44.4% (20 out of 45) of our population safely to home with no need for further diagnostic cardiac testing. The rest of the patients were classified into significant coronary artery disease 40% (18 out of 45), 8.8% (4 out of 45) had acute aortic lesions and 6.6% (3 out 45) had pulmonary artery embolization.Conclusions: Triple Role Out CT angiography (TRO CTA) is not only an effective protocol for exclusion of ACS with high specificity compared to dedicated coronary CTA but also in the diagnosis of acute chest pain due to other vascular and non-vascular causes helping decision-making strategy for admission in the emergency department.

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Effect of preoperative evaluation by multidetector computed tomography in percutaneous coronary interventions of chronic total occlusions

Cited by 9 publications

References 28 publications

Coronary CT Angiography in Managing Atherosclerosis

Coronary CT Angiography in Managing Atherosclerosis

Efficacy of Coronary Computed Tomography Angiography for the De Novo Detection of Chronic Total Occlusion Prior to Coronary Angiography: A Preliminary and Retrospective Study

‘Triple-rule-out’ CT angiography for clinical decision making and early triage of acute chest pain patients: use of 320-multislice CT angiography

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