The role of coronary CT angiography in chronic total occlusion intervention

Revascularisation by percutaneous coronary intervention (PCI) in chronic total occlusion (CTO) is often a technically challenging procedure. The manipulation of wires and devices through a CTO during PCI without any means to visually identify vessel-wall boundaries involves an inherent risk of complications such as arterial dissection, perforation and cardiac tamponade. With the tremendous advances in multidetector CT technology and the popularity of utilising coronary CT angiogram (CCTA) for a workup of chest pain patients, an increasing number of CTO cases are being encountered. Therefore, the primary goal of CCTA for imaging in CTOs involves identifying the presence and locations of CTO as well as predicting the potential clinical benefits derived from revascularisation of the occluded segment. The secondary goal includes preprocedural planning to shorten procedure times, visualisation of the procedure in predicting the ease with which a CTO can be crossed and the frequency of procedure-related complications such as contrast nephropathy and radiation skin injury. Apart from these, CCTA also plays a role in postprocedural assessment of the revascularised arterial segments and long-term follow-up on the patency of coronary stents.