Dual-Source Computed Tomography for Chronic Total Occlusion of Coronary Arteries
Sandeep Singh1, Navreet Singh1, Gurpreet S Gulati2
1Department of Cardiology, All India Institute of Medical Sciences, New Delhi, 110029, India.
Insights
Dual-source CT (DSCT) offers comparable evaluation of coronary artery chronic total occlusions (CTO) to conventional angiography (CA). DSCT excels in visualizing calcification and distal vessels, making it a valuable pre-intervention tool.
Area of Science:
- Cardiovascular imaging
- Interventional cardiology
- Diagnostic radiology
Background:
- Percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) presents technical challenges and lower success rates.
- Accurate assessment of lesion morphology is crucial for successful CTO intervention.
Purpose of the Study:
- To compare the diagnostic performance of dual-source CT (DSCT) and conventional angiography (CA) in evaluating coronary artery CTO.
- To determine the utility of DSCT as a pre-intervention tool for CTO.
Main Methods:
- Nineteen patients with CTO confirmed by CA underwent DSCT without heart rate control.
- Lesion characteristics including bridging collaterals, stump morphology, calcification, side branches, tortuosity, occlusion length, and distal vessel interpretability were analyzed.
- Statistical comparison of features between DSCT and CA was performed using dedicated post-processing software.
Main Results:
- DSCT identified calcification in 60% of lesions compared to 25% with CA (P=0.025), with better visualization of its nature and extent.
- Distal vessel interpretability was significantly better with DSCT (75%) than CA (45%) (P=0.05).
- Bridging collaterals were identified by CA but not DSCT; stump anatomy and side branches were equally visualized.
Conclusions:
- DSCT demonstrates comparable performance to CA for most CTO features.
- DSCT's ability to detect and characterize calcium, interpret distal vessels, and avoid heart rate control makes it a valuable pre-intervention imaging modality.
- DSCT is a useful tool for pre-procedural assessment of coronary artery chronic total occlusions.
Objectives:
We compared dual-source CT (DSCT) and conventional angiography (CA) in evaluation of chronic total occlusion (CTO) of coronary arteries.
Background:
Percutaneous coronary intervention (PCI) in CTO is technically difficult and has comparatively lower success rate than intervention in non-occluded artery. Accurate assessment of lesion morphology is an important determinant of PCI success in CTO.
Methods:
Nineteen symptomatic patients (18 men, age: 58.6 ± 10.6 years) with a CTO on CA were subjected to a DSCT (Definition, Siemens, Germany). Heart rate (HR) control was not performed. Dedicated post-processing software was used for lesion analysis on both modalities. Presence of bridging collaterals, stump morphology, calcification, side branch, proximal tortuosity, occlusion length, distal vessel interpretability, and distal lesions were statistically compared.
Results:
There were 20 CTOs. HR during DSCT ranged from 53 to 131 bpm. Bridging collaterals were seen in 3/20 (15%) lesions on CA and in none on DSCT. Stump anatomy and side branch were identified equally well. Plaque calcification was identified in 5/20 (25%) lesions on CA and in 12/20 (60%) lesions on DSCT (P = 0.025). Nature and extent of calcification were better visualized on DSCT. No proximal tortuosity was noted. Distal vessel was better interpretable on DSCT (15/20; 75%) compared to CA (9/20; 45%) (P = 0.05). No significant difference in lesion length was noted.
Conclusion:
DSCT performs as well as CA for most features of CTO. Avoidance of need to control HR, ability to better detect and characterize calcium and to interpret distal vessels make it a useful pre-intervention investigation. © 2014 Wiley Periodicals, Inc.
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