CT Angiography for Revascularization of CTO Crossing the Borders of Diagnosis and Treatment

JACC-CARDIOVASCULAR IMAGING

卷:8

Article

Opolski, Maksymilian P.¹  Achenbach, Stephan² 

[1] Inst Cardiol, Dept Intervent Cardiol & Angiol, PL-04628 Warsaw, Poland

[2] Univ Erlangen Nurnberg, Dept Internal Med Cardiol 2, D-91054 Erlangen, Germany

关键词: chronic total occlusion;    coronary angiography;    coronary computed tomography angiography;    percutaneous coronary intervention;   

DOI  :  10.1016/j.jcmg.2015.05.001

来源: Elsevier

【 摘 要 】

Coronary computed tomography angiography (CTA) is increasingly used to diagnose and rule out coronary artery disease. Beyond stenosis detection, the ability of CTA to visualize and characterize coronary atherosclerotic plaque, as well as to obtain 3-dimensional coronary vessel trajectories, has generated considerable interest in the context of pre-procedural planning for revascularization of chronic total occlusions (CTOs). Coronary CTA can characterize features that influence the success rate of percutaneous coronary intervention (PCI) for CTOs such as the extent of calcification, vessel tortuosity, stump morphology, presence of multiple occlusions, and lesion Length. Single features and combined scoring systems based on CTA may be used to grade the level of difficulty of the CTOs before PCI and have been shown to predict procedural success rates in several trials. In addition, the procedure itself may be facilitated by real-time integration of 3-dimensional CTA data and fluoroscopic images in the catheterization laboratory. Finally, the ability of coronary CTA to assess anatomy, perfusion, and viability in 1 single examination makes it a potential one stop shop that predicts not only the Likelihood of successful PCI but also the clinical benefit of CTO revascularization. Further research is clearly needed, but many experienced sites have already integrated coronary CTA into the routine planning and guiding of CTO procedures. (C) 2015 by the American College of Cardiology Foundation.

【 授权许可】

Free