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06:29
Cardiac Magnetic Resonance for the Evaluation of Suspected Cardiac Thrombus: Conventional and Emerging Techniques
Published on: June 11, 2019
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Patient Selection and Clinical Indication for Chronic Total Occlusion Revascularization-A Workflow Focusing on
Kevin Hamzaraj1, Andreas Kammerlander1, Mariann Gyöngyösi1
1Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria.
Life (Basel, Switzerland)
|January 21, 2023
Summary
Percutaneous coronary intervention for chronic total occlusion (CTO PCI) is complex. This review guides selecting patients for CTO PCI using non-invasive imaging to assess myocardial viability and optimize outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Imaging
Background:
- Chronic total occlusion percutaneous coronary intervention (CTO PCI) presents challenges with unclear long-term benefits.
- Current guidelines recommend CTO PCI for symptom relief in patients with high ischemic burden, targeting viable myocardial territories.
- Non-invasive imaging is crucial for selecting CTO PCI candidates, but modality choice lacks clear recommendations.
Purpose of the Study:
- To review current myocardial imaging tools for indicating CTO PCI.
- To propose a systematic, cost-effective approach for myocardial assessment in CTO PCI candidate selection.
Main Methods:
- Comprehensive review of current non-invasive cardiac imaging techniques.
- Analysis of their utility in assessing myocardial viability for CTO PCI.
- Proposal of an experienced-center-based, systematic evaluation process.
Main Results:
- Non-invasive imaging is vital for risk-benefit assessment in CTO PCI.
- No standardized approach exists for pre-CTO PCI myocardial evaluation.
- Physician discretion currently dictates imaging modality selection.
Conclusions:
- A systematic, cost-effective myocardial assessment strategy is needed to guide CTO PCI decisions.
- Experienced centers should encourage comprehensive non-invasive imaging for patient selection.
- Optimizing patient selection through imaging can improve CTO PCI outcomes.
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