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Published on: February 10, 2012
Feasibility of computed tomography perfusion in patients with chronic total occlusion undergoing percutaneous
Maksymilian P Opolski1, Jacek Kwiecinski1, Anna Oleksiak2
1Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland.
Insights
Dynamic computed tomography perfusion (CTP) is a safe and feasible method for assessing myocardial blood flow in chronic total occlusion (CTO) patients undergoing percutaneous coronary intervention (PCI). Successful PCI significantly improves perfusion defects, but residual deficits persist compared to normal myocardium.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Chronic total occlusion (CTO) poses challenges in coronary artery disease management.
- Assessing myocardial perfusion in CTO patients is crucial for treatment planning and outcome evaluation.
- Dynamic computed tomography perfusion (CTP) offers a non-invasive method for quantitative myocardial blood flow assessment.
Purpose of the Study:
- To evaluate the feasibility and safety of dynamic CTP in patients with CTO undergoing percutaneous coronary intervention (PCI).
- To quantify changes in myocardial blood flow (MBF) and perfusion defect size before and after successful CTO PCI.
- To compare myocardial perfusion in CTO patients with a control group.
Main Methods:
- Ten CTO patients with preserved left ventricular ejection fraction underwent regadenoson dynamic CTP pre- and post-PCI.
- Quantitative absolute and indexed stress MBF were measured, and perfusion defect size was defined.
- A control group of 10 subjects without ischemia was included for comparison.
Main Results:
- Dynamic CTP was highly interpretable (97.2%) with a low radiation dose (589.5 ± 144.3 mGy cm) and no severe adverse reactions.
- Successful PCI significantly increased stress MBF in CTO patients (p=0.004).
- Significant reductions in CTO and total perfusion defect size were observed post-PCI (p=0.002), though residual defects remained compared to controls.
Conclusions:
- Dynamic CTP is a feasible and safe imaging modality for evaluating myocardial perfusion in CTO patients.
- Successful CTO PCI leads to significant improvement in myocardial perfusion.
- Residual ischemic burden persists even after successful revascularization, highlighting the complexity of CTO.
Abstract:
We aimed to establish the feasibility and safety of dynamic computed tomography perfusion (CTP) in patients with chronic total occlusion (CTO) undergoing percutaneous coronary intervention (PCI). Ten consecutive CTO patients with preserved left ventricular ejection fraction (≥50%) underwent regadenoson dynamic CTP prior to and at least 3 months after successful CTO recanalization. Quantitative absolute and indexed values of stress myocardial blood flow (MBF) were measured for each myocardial segment, and perfusion defect size was defined by the number of segments with indexed MBF ≤0.78. The control group comprised 10 subjects without ischemia on CTP. Out of 20 CTP studies with 320 segments, 311 segments (97.2%) were interpretable. The dose-length product for CTP was 589.5 ± 144.3 mGy cm, and no severe adverse reactions to either regadenoson or contrast were observed. Successful PCI resulted in a significant increase in stress MBF in CTO (101.8 [82.9-127.1] vs. 158.4 [132.6-172] ml/100ml/min, p = 0.004). Overall, there were significant reductions in both CTO and total defect size post-PCI (5 [5-6] vs. 1 [0.3-2] and 6 [5-8.5] vs. 1.5 [1-3.8] segments, both p = 0.002). In segment analysis, the indexed MBF was lowest in the pre-PCI CTO group (0.90 [0.53-1.0]), followed by post-PCI CTO group (0.96 [0.88-1.0]) and the control group (0.98 [0.94-1.0]). Dynamic CTP is feasible and safe, and shows large perfusion defects in patients with CTO. While ischemic burden can be significantly improved after successful CTO PCI, it is still larger as compared with normal myocardium. NCT04465526: The Influence of Coronary Chronic Total Occlusion on Myocardial Perfusion on Computed Tomography (COPACABANA).
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