The Role of Multimodality Imaging for Percutaneous Coronary Intervention in Patients With Chronic Total Occlusions

Frontiers in Cardiovascular Medicine

article

Eleonora Melotti¹  Marta Belmonte¹  Carlo Gigante¹  Vincenzo Mallia¹  Saima Mushtaq¹  Edoardo Conte¹  Danilo Neglia²  Gianluca Pontone¹  Carlos Collet⁴  Jeroen Sonck⁴  Luca Grancini¹  Antonio L. Bartorelli¹  Daniele Andreini¹ 

[1] Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico;Fondazione Toscana G. Monasterio;Istituto di Scienze della Vita Scuola Superiore Sant'Anna;Cardiovascular Center Aalst, OLV-Clinic;Department of Advanced Biomedical Sciences, University of Naples Federico II;Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan

关键词: multimodality imaging;    chronic total occlusion (CTO);    cardiac CT;    cardiac magnetic resonance;    single photon emission computed tomography (SPECT);    echocardiography;    percutaneous coronary intervention (PCI);   

DOI  :  10.3389/fcvm.2022.823091

学科分类：地球科学(综合)

来源: Frontiers

【 摘 要 】

Background Percutaneous coronary intervention (PCI) of Chronic total occlusions (CTOs) has been traditionally considered a challenging procedure, with a lower success rate and a higher incidence of complications compared to non-CTO-PCI. An accurate and comprehensive evaluation of potential candidates for CTO-PCI is of great importance. Indeed, assessment of myocardial viability, left ventricular function, individual risk profile and coronary lesion complexity as well as detection of inducible ischemia are key information that should be integrated for a shared treatment decision and interventional strategy planning. In this regard, multimodality imaging can provide combined data that can be very useful for the decision-making algorithm and for planning percutaneous CTO recanalization. Aims The purpose of this article is to appraise the value and limitations of several non-invasive imaging tools to provide relevant information about the anatomical characteristics and functional impact of CTOs that may be useful for the pre-procedural assessment and follow-up of candidates for CTO-PCI. They include echocardiography, coronary computed tomography angiography (CCTA), nuclear imaging, and cardiac magnetic resonance (CMR). As an example, CCTA can accurately delineate CTO location and length, distal coronary bed, vessel tortuosity and calcifications that can predict PCI success, whereas stress CMR, nuclear imaging and stress-CT can provide functional evaluation in terms of myocardial ischemia and viability and perfusion defect extension.

【 授权许可】

CC BY