Related Experiment Video
Updated: May 24, 2026
Four-Dimensional Computed Tomography-Guided Valve Sizing for Transcatheter Pulmonary Valve Replacement
Published on: January 20, 2022
Factors determining success in percutaneous revascularization of chronic total coronary occlusion: multidetector
Victoria Martín-Yuste1, Antonio Barros, Ruben Leta
1Servicio de Cardiología, Instituto del Tórax, Hospital Clínic, Barcelona, Spain. 27700vmy@comb.cat
Insights
Multidetector computed tomography can predict failure in chronic total coronary occlusion revascularization. Calcium affecting over 50% of the vessel circumference is a key indicator, aiding patient selection for percutaneous coronary intervention.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Percutaneous revascularization for chronic total coronary occlusion (CTO) presents significant technical challenges.
- CTO procedures have a lower success rate compared to other angioplasty interventions.
- Identifying predictors of failure is crucial for optimizing patient selection and improving procedural outcomes.
Purpose of the Study:
- To investigate multidetector computed tomography (MDCT) features associated with percutaneous treatment failure in CTO.
- To identify novel predictors of failure beyond traditional angiographic factors.
Main Methods:
- Prospective, single-center study involving 69 consecutive patients with CTO.
- MDCT imaging was performed prior to percutaneous coronary revascularization.
- Analysis of 77 CTO lesions, evaluating angiographic and MDCT characteristics.
Main Results:
- A severe curve between the plaque and proximal patent vessel was the only independent angiographic predictor of failure (OR 3.8, P=.02).
- MDCT revealed that extensive calcification (affecting >50% of the vessel circumference) in the proximal and middle thirds of the occlusion predicted failure (P=.04 and P=.03, respectively).
- This calcification parameter is not measurable by conventional angiography.
Conclusions:
- MDCT can identify a significant predictor of failure in CTO revascularization that is not apparent on angiography.
- The presence of extensive calcification on MDCT may guide pre-procedural screening and patient selection for CTO interventions.
- MDCT offers valuable insights for improving the success rates of complex percutaneous coronary interventions.
Introduction And Objectives:
Percutaneous revascularization of chronic total coronary artery occlusion is a technical challenge and has a lower success rate than other angioplasty procedures. Identification of predictors of failure could lead to better selection of patients with the greatest possibility of success. In this study, we investigate the multidetector computed tomography features associated with failure of percutaneous treatment for chronic total coronary occlusion.
Methods:
This is a prospective, single-center study of 69 consecutive patients with chronic total occlusion in whom multidetector computed tomography study was performed before percutaneous coronary revascularization.
Results:
Seventy-seven lesions were analyzed. The mean length of the occlusion was 19.9 (14.3) mm and the estimated duration of occlusion was 47 (62) months. The only angiographic factor independently predictive of failure was a severe curve between the plaque and the proximal patent vessel (odds ratio 3.8, 95% confidence interval, 1.2-12; P=.02). On multidetector computed tomography, the only factor predictive of failure was an arc of calcium affecting more than 50% of the vessel circumference in the proximal (P=.04) and middle (P=.03) third of the occlusion.
Conclusions:
Multidetector computed tomography identified a variable that cannot be measured by angiography that can predict failure in percutaneous revascularization of chronic total coronary occlusions. In selected cases, this parameter could be useful for preprocedure screening.
Related Concept Videos
01:28Imaging Studies for Cardiovascular System V: CT
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT