Percutaneous coronary intervention for chronic total occlusion: novel 3-dimensional imaging and quantitative analysis

The purpose of this study was to evaluate chronic total occlusion (CTO) lesions in three dimensions (3D) and to examine the potential yield and added diagnostic value of these reconstructions in planning percutaneous interventional procedures.

The novel CardiOp-B system for 3D reconstruction of the coronary vessels was used in 302 angiographic images from 58 consecutive patients (86% men; mean age 62 +/- 11 years) undergoing interventional treatment for CTO (61 CTOs). The success rate of 3D reconstruction was 83%. When successful, these reconstructions led to a significant improvement in lesion analysis, especially at the stump area and/or missing segment. Importantly, in 92% of the successful 3D reconstructions, the artery path in the lesion area could be delineated. In 95% of cases, in which post-stenting 3D reconstruction performed, the vessel path was similar to the lesion path suggested before stenting. The mean stenosis area was significantly smaller in the 3D reconstructions vs. 2D images (94 +/- 5.1% vs. 99 +/- 0.3%, P < 0.001), and the mean lesion length was significantly shorter (15.3 +/- 7.4 mm vs. 20.9 +/- 8 mm, P < 0.001).

In most cases, 3D reconstruction of CTOs can clearly image the stump area, delineate the lesion path, and provide enough information for the clinician to precisely calculate the severity of stenosis and lesion length. 3D reconstructions may serve as a useful tool for planning interventional procedures for CTOs and improving their success rate.