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Journal of Zhejiang University SCIENCE B 2010 Vol.11 No.8 P.568-574

http://doi.org/10.1631/jzus.B1001013


Computed tomography angiography-guided percutaneous coronary intervention in chronic total occlusion


Author(s):  Ping Li, Lu-yue Gai, Xia Yang, Zhi-jun Sun, Qin-hua Jin

Affiliation(s):  Department of Cardiology, Chinese PLA General Hospital, Beijing 100853, China

Corresponding email(s):   luyuegai301@yahoo.com.cn

Key Words:  Dual-source computed tomography (DSCT), Chronic total occlusion (CTO), Angiography, Recanalization


Ping Li, Lu-yue Gai, Xia Yang, Zhi-jun Sun, Qin-hua Jin. Computed tomography angiography-guided percutaneous coronary intervention in chronic total occlusion[J]. Journal of Zhejiang University Science B, 2010, 11(8): 568-574.

@article{title="Computed tomography angiography-guided percutaneous coronary intervention in chronic total occlusion",
author="Ping Li, Lu-yue Gai, Xia Yang, Zhi-jun Sun, Qin-hua Jin",
journal="Journal of Zhejiang University Science B",
volume="11",
number="8",
pages="568-574",
year="2010",
publisher="Zhejiang University Press & Springer",
doi="10.1631/jzus.B1001013"
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%0 Journal Article
%T Computed tomography angiography-guided percutaneous coronary intervention in chronic total occlusion
%A Ping Li
%A Lu-yue Gai
%A Xia Yang
%A Zhi-jun Sun
%A Qin-hua Jin
%J Journal of Zhejiang University SCIENCE B
%V 11
%N 8
%P 568-574
%@ 1673-1581
%D 2010
%I Zhejiang University Press & Springer
%DOI 10.1631/jzus.B1001013

TY - JOUR
T1 - Computed tomography angiography-guided percutaneous coronary intervention in chronic total occlusion
A1 - Ping Li
A1 - Lu-yue Gai
A1 - Xia Yang
A1 - Zhi-jun Sun
A1 - Qin-hua Jin
J0 - Journal of Zhejiang University Science B
VL - 11
IS - 8
SP - 568
EP - 574
%@ 1673-1581
Y1 - 2010
PB - Zhejiang University Press & Springer
ER -
DOI - 10.1631/jzus.B1001013


Abstract: 
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.

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