CT angiography versus invasive angiography for the diagnosis of total occlusion

Computed tomography coronary angiography (CTCA) for the diagnosis and evaluation of coronary artery occlusive disease has rapidly gained acceptance among clinicians. Its growing use in selected populations has provided a wealth of data, leading to a recent flurry of articles describing both the benefits and limitations of this imaging modality. In this article, we describe the case of an 80 year old woman who presented with anginal symptoms, who first underwent CTCA which suggested severe right coronary artery stenosis. A subsequent invasive coronary angiogram was crucial in revealing a total occlusion and the presence of collateral vessels, findings that would ultimately guide therapy. This case demonstrates a significant limitation in the use of CTCA and the associated images are valuable in illustrating this point.