Abstract 2327: Predictors Of Procedural Outcome In Percutaneous Coronary Intervention For Chronic Total Occlusions: Value Of Preprocedural Multislice Computed Tomographic Coronary Angiography
Purpose: Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) is still one of the challenging procedures. Multislice computed tomographic coronary angiography (CTCA) allows reliable non-invasive evaluation of coronary artery by visualizing calcium deposit, vessel tortuosity, distal flow, etc. even in the occluded site. The aim of this study is to determine the morphological predictors of procedural success in PCI for CTO using CTCA, and to estimate the value of CTCA to predict procedural outcome.
Methods: Using Somatom Sensation Cardiac 64, we performed CTCA in 91 patients who have CTO prior to PCI, and 93 CTO lesions were scanned. CTO was defined as complete occlusion of a major coronary artery on catheter coronary angiography, which was deemed to be of > 3 months’ duration. Procedural success was defined as complete cross of the guidewire to the occluded site. Retrograde approach, in which the guidewire was advanced from the distal end of the occluded site through the collateral flow, was also tried in 32 lesions. We divided lesions in successful and unsuccessful groups, and following parameters were compared between groups to determine the predictors of procedural outcome: target vessel bending (defined as > 45 degree), shrinkage of occluded vessel, severe calcification, side branch at occlusion site, stamp morphology, in-stent occlusion and occlusion length.
Results: Seventy-eight lesions (84%) resulted in successful procedure. The rates of bending, shrinkage and severe calcification were significantly higher in unsuccessful group (19% vs. 73%, p < 0.0001; 3% vs. 33%, p < 0.0001; 6% vs. 27%, p = 0.0151). Stamp morphology, in-stent occlusion or occlusion length did not show significant difference between groups.
Conclusion: Vessel bending, shrinkage and severe calcification are significant predictors for procedural failure. Preprocedural CTCA allows to provide practical information about procedural outcome of PCI for CTO.