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(Circulation. 2006;113:1053-1055.)
© 2006 American Heart Association, Inc.

Editorial

Is Magnetic Resonance Image Guidance the Key to Opening Chronic Total Occlusions?

Donald S. Baim, MD; Raymond Y. Kwong, MD

From the Cardiovascular Division, Center for Integration of Medicine and Innovative Technology (D.S.B.) and Cardiac Magnetic Resonance Imaging (R.Y.K.), Brigham and Women’s Hospital, Boston, Mass.

Correspondence to Donald S. Baim MD, Cardiovascular Division, Center for Integration of Medicine and Innovative Technology, Brigham and Women’s Hospital, 1620 Tremont St, Boston MA 02120. E-mail dbaim@partners.org

Key Words: Editorials • angioplasty • imaging • magnetic resonance imaging • occlusion

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Through progressive plaque growth or fibrotic organization of occlusive thrombus, atherosclerosis may result in chronic total occlusion (CTO) of a major arterial conduit. If CTO develops slowly, collateral pathways may supply sufficient perfusion to retain tissue viability despite occlusion of the major inflow conduit. However, such collateral-mediated perfusion rarely matches that provided by an open main conduit, particularly during the peak demand of regional muscular activity. Although strategies to limit regional oxygen demand (eg, ß-blockers for the treatment of angina pectoris) or to enhance collateral function (eg, a walking program for superficial femoral occlusion, experimental angiogenesis) may be of some benefit, these approaches generally offer less complete return of normal physiology and relief of ischemic symptoms than does direct revascularization of the occluded vessel. With surgical bypass, the nature of the occlusion (its length, duration, tortuosity, calcification) is less important than the presence of a suitable distal anastomotic target. On the other hand, with catheter-based techniques, success depends heavily on these lesion characteristics. In fact, crossing such occluded segments with a guidewire remains the dominant barrier to catheter-based treatments of occluded arterial segments. Once the guidewire has been passed successfully into the distal true lumen, the process of dilating and stenting the segment is usually straightforward and durable, at least with the use of drug-eluting stents in coronary CTOs.^1,2

Article p 1101

Devices designed to cross CTOs should have 3 key features: an ability to distinguish a true luminal path from one created within (dissection) or through (perforation) the vessel . . . [Full Text of this Article]