Three-Dimensional Quantitative Volumetry of Chronic Total Occlusion Plaque Using Coronary Multidetector Computed Tomography

Abstract

Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp espite remarkable progress in the technique of percutaneous coronary intervention (PCI), the recanalization of chronic total occlusion (CTO) of native coronary artery remains as one of the major challenges in interventional cardiology. 1-4 The success rates of top level operators are still considerably lower than those achieved in non-occluded coronary arteries or acutely occluded arteries by average-volume operators. 5-7One of the major hurdles of CTO PCI is the inability to visualize the exact vessel course, size, and hardness because of the inability to obtain luminal continuity on traditional coronary angiography. Multidetector computed tomography (MDCT) has been used as a valuable non-invasive tool for evaluation of coronary artery atherosclerotic plaque. 8-14 Furthermore, recent developments in MDCT technology, including increased detectors and dedicated coronary artery analysis software, have enabled sophisticated volumetric plaque analysis on intravascular ultrasound (IVUS). 15, 16 We therefore reasoned that MDCT can provide additional information beyond coronary angiography, and can predict the success of CTO PCI. Background: The purpose of the present study was to investigate whether multidetector computed tomography (MDCT) can identify the nature of chronic total occlusion (CTO) plaque, which cannot be measured quantitatively using traditional coronary angiography, and predict the success of percutaneous coronary intervention (PCI).

Noninvasive Discrimination of Coronary Chronic Total Occlusion and Subtotal Occlusion by Coronary Computed Tomography Angiography

“…In our study, the calcification did not affect the procedural result, which is similar to our prior study (16). This finding is partially explained by the poor performance of CTA for discrimination of hard fibrous tissue from calcified tissue, which shows distinct HU values but blocks guidewire advancement, or for detection of small calcification (13,26).…”

Predictors of Interventional Success of Antegrade PCI for CTO

“…Despite the lack of visualization of the occluded CTO segments, CCA remains the reference standard for evaluating coronary anatomy (2,14,15). Recently, the superiority of coronary computed tomography angiography (CTA) for directly observing morphological characteristics of occluded lesions, especially calcification, was highlighted (14,15).…”

“…Recently, the superiority of coronary computed tomography angiography (CTA) for directly observing morphological characteristics of occluded lesions, especially calcification, was highlighted (14,15). Rolf et al (3) found that pre-procedural coronary CTA was associated with a higher PCI success rate than lack of preprocedural coronary CTA.…”

Frequency of Myocardial Infarction and Its Relationship to Angiographic Collateral Flow in Territories Supplied by Chronically Occluded Coronary Arteries

“…2 Despite the complete interruption of antegrade coronary artery blood flow caused by heavy atherosclerotic plaque burden, clinical recognition of myocardial infarction (MI) can be challenging. [3][4][5][6] The latter can have important implications especially with respect to decisions regarding myocardial revascularization.…”